Association between Fruit and Vegetable Intake and Physical Activity among Breast Cancer Survivors: A Longitudinal Study

Round 1

Reviewer 1 Report

Breast cancer is the most common cancer in women worldwide.

Diet and physical activity may affect the prognosis among women who are diagnosed with breast cancer. This article addresses an important area of research.

Below are presented detailed comments, which according to the reviewer, should be included in the manuscript or should be responded to by the Authors.

Introduction –

• should be shortened, there are numerous repetitions

lines 29-30 Unhealthy dietary behaviors and physical inactivity are prevalent in a majority of  adults during and after treatment for cancer [1-4].

Lines 30-31: Unhealthy dietary behaviors and physical inactivity tend to co-occur among cancer survivors [1,5],

Lines 33-34 The co-occurrence of unhealthy dietary behaviors  and physical inactivity may have detrimental synergistic effects on cancer survivors’ health and well-being.

it is the same

lines 31-32 people who  typically eat less fruits and vegetables also typically engage in less moderate-to-vigorous 32 intensity physical activity (MVPA). – please add the references

I suggest that the text contained in lines 29-45 could be reduced to 3 sentences 

Lines 85-89 - this is a good paragraph, please connect it to the next paragraph  (lines 90-99) without unnecessary repetition

Materials and Methods:

The group selection was intentional and not random, I think this could have an impact on the results

Lines 118-119: „diagnosed with stage I to III breast cancer, and completed primary treatment within the 20 weeks prior to study participation” what it means to complete primary treatment - was it a surgical treatment?

Were the women in the study treated with complementary therapy (e.g. radiotherapy, chemotherapy, hormone therapy?). The complementary treatment may have an impact on physical activity levels and diet

Lines 117- 121. The inclusion and exclusion criteria should be better defined

Measures

Fruit and Vegetable Intake is a subjective assessment (questionnaire), assessment of physical activity level is an objective assessment (GT3X accelerometer). Did the subjects also keep a fruit and vegetable diary?

Results

The studies have the benefit of being continuous over a period of 15 months

Tab. 1. Whether the patients were in active cancer treatment (radiotherapy, chemotherapy)? If so, this may have an effect on the results!

Have you had hormone therapy or other forms of treatment?

Discussion

            this section is more a description of the results, please complement the discussion with data available from other authors

Lines 272-273 both behaviors tend to decrease from three months post treatment (baseline; Time 1) to 15 months post-treatment (Time 5). Whether post-treatment means finished oncology treatment? if not - an extra variable is included.

Lines 317-318 the GT3X accelerometer is not waterproof. Hence, study participants were asked to remove the accelerometer when engaging in water based activities (e.g., swimming, aqua fitness classes, aquabiking). – were respondents participating in such activities, was there any assessment of the type of activities undertaken through the questionnaire?

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

The manuscript entitled ‘Association between fruit and vegetable intake and physical activity among breast cancer survivors: A longitudinal study” presents interesting issue, however some corrections are needed

• The abstract should be a single paragraph and should follow the style of structured abstracts, but without headings:
• ‘The items used have been validated against three 24-hour recalls and found to be a good proxy of fruit and vegetable servings in a sample of adults 18-64 142 years of age [38].’ – please add more information about the validity and reliability. Additionally, any limitations in reliability and validity need to be addressed in the discussion.
• Moderate-to-Vigorous Intensity Physical Activity (MVPA). – please add the add some information about the validity and reliability (if available). Any issue related to bias should be discussed.
• ‘models with a non-significant MLRχ2, CFI and TLI values ≥ .95, RMSEA values ≥ .06, and SRMR values ≥ .08 were considered to indicate acceptable fit’ – please add the reference for this cut-of values (especially for RMSEA)
• Line 250 ‘were not significantly associated’ – it should be ‘were not associated’
• Authors should in their discussion include 3 areas: (1) compare gathered data with the results by other authors, (2) formulate implications of the results of their study and studies by other authors, (3) formulate the future areas which should be studied.

Minor comments:

• There are some typos -e.g. ‘change [336,46], and”

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

In this study, the authors examine the association between rate of changes in fruit and vegetable intake and levels of moderate-to-vigorous intensity physical activity (MVPA) over a 15-month period, following primary treatment completion in breast cancer patients. The manuscript is straightforward, well written, and concise and has clear results within the scope of a retrospective study. Definitely deserves to be published and is a valuable contribution to the “Current Oncology” journal. Some minor flaws need to be addressed before publication.

Minor points:

[1] “1. Introduction”, Page 1, Lines 29-30:

“Unhealthy dietary behaviors and physical inactivity are prevalent in a majority of adults during and after treatment for cancer [1-4].”.

I recommend the authors to mention that the risk factors for chemotherapy-associated thrombosis can be broadly categorised into patient characteristics, tumour related factors, treatment options and biomarkers. In terms of the factors increasing risk of venous thromboembolism, along with the prior history of VTE and a BMI > 35 kg/m2, it is is included the immobility, which causes stasis of venous blood flow.

Recommended reference: Shah S, et al. Cancer-Associated Thrombosis: A New Light on an Old Story. Diseases. 2021;9(2):34.

[2] The introdustion is too long; even longer than the discussion section.

[3] “Table 1. Sample Descriptive Characteristics (N = 199)”, Page 5, Lines 193:

It would be interesting to incorporate the following variables, if this is feasible:

1. Family predisposition (Yes vs no)

2. Menopausal status (Premenopausal vs postmenopausal)

3. Surgery (Mastectomy vs lumpectomy)

4. Hormonal treatment (Yes vs no)

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

the authors have responded to the questions and have revised the manuscript