“Partner”, “Caregiver”, or “Co-Survivor”—Might the Label We Give the Partners of Cancer Patients Affect the Health Outcome of the Patients and Their Partners?

Round 1

Reviewer 1 Report

The authors bring up an interesting discussion about how to refer to partner of cancer patients, through the label of “caregiver”, “partner” or “co-survivor” and clinical suggestions. Although the authors develop their point of view and state different arguments, partly based on articles, I think their argument could be better brought. I hope my comments will be received in the same way in which they are intended – as positive and constructive encouragement.

I find that the way the article is organized sometimes serves the authors' thinking. I think it is important to review the organization of the ideas and the thread of this article. The summary of the article seems to me much clearer than the core of the article.

For example:

In “introduction”: I think it is important to improve the transition between the state of the art of the importance of spouses (p1, lines 24-32) and the part on the importance of labels (p1, lines 32-38). I find this whole 2nd part (p1, lines 32-38) out of place at this stage of the article and does not provide sufficiently enlightening information. Is it a kind of summary of the article? If so, shouldn't it appear later? I think that the theme of this article is not sufficiently explained and introduced.

In “ co-survivor” a better term?: The authors explain that other authors before them have criticized the "caregiver" label (p2, lines 59-61), without really explaining why. Is it only the supposed "emotional burden" that is to be taken into account? Would it be possible to explain this argument further? And aren't there other possible arguments (such as the fact that caregivers/spouses don't necessarily consider themselves as "caregivers"...)? Before specifying what the alternatives might be ("co-survivor "), I think the authors need to explain more clearly why the term « caregiver » should be replaced. Same for « co-survival ».

In “Concordance and contrast in couples’ coping styles”: Without transitioning from the previous part, I don't understand what this part is for. What is the link with the previous one? Why, all of a sudden, bring up coping styles? The link between this part and the reflection on labels does not seem to be explained.

In “Sexual intimacy between a patient and a caregiver”: The authors return to the concept of caregiver with a new argument. Why not bring all the arguments together in a coherent and organized way? ; Moreover, the authors' views on the impact of the label "caregiver" on the couple's sexual life should be further supported by references. To my knowledge, there is no empirical data to support this. Is it not more the way in which each member of the couple perceives his or her role and that of the other, in this context of illness, that will impact their sexuality?

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

General comments for the Editor and authors: Thank you for the opportunity. This perspective described the influence of labelling partners of patients with cancer on health outcomes. They provided strategies on how to help couples cope with the challenges of cancer. This paper would interest researchers focusing on dyad-based research and clinicians who provide holistic care for patients and their families. However, the authors viewed the patient and caregiver as isolated individuals. Increasingly patients and caregivers are viewed as a unit in cancer experiences. There is a lack of overall understanding about patient and caregiver function as a unit, how their physical and psychological status affects each other, how the developmental stage would influence the dyadic coping. For example, a large body of literature was missing here, including the status of caregiving burden, lack of support for a partner in clinical settings, theoretical support for promoting dyadic coping, the linkage between supporting dyad with their health outcomes. In addition, the relationship between labelling "caregiver" with health outcomes was never established in this paper. Detailed comments by the manuscript section are provided below. Hopefully, these comments will help the authors to strengthen their manuscript.

 

• In general, the patients with cancer is a widely used term. Please consider changing the term.
• The relationship between labelling "caregiver" the health outcomes is not clear.
• Line 27-28: please clarify, what do ten cancers mean here?
• In the introduction, the authors do not build a strong case for suggesting replacing "caregiver" with "partner." There is no definition of the caregiver or long-term partner. The readers would benefit from the information about why "caregiver" was commonly used in cancer literature, which might affect how partner perceive their role in patient's recovery and their perceived burden being a “caregiver."
• Figure 1, lines 55-57, it is unclear how many papers referred to patients and caregivers focused on patients and partners. For example, some of these papers in orange dot might focus on caregivers with partners included. Please clarify.
• Line 78-82: "survivor" does not imply any curative intent. Instead, it implies the long-term management of cancer. However, again, the authors could use other references to support the assumption.
• Line 84-95: The information provided here suggests a sex/gender difference in experiencing cancer-related distress and coping style. Is this the main point here? From my understanding, there was discordance between patients' and partners' cancer experiences. There is a large body of literature guided by the dyadic coping in patient-caregiver dyads in cancer. It would be worthwhile to mention the dyadic coping research here to address discordance and concordance in coping style and cancer experience in patients and partners.
• There is a lack of information about concordance in couples' coping styles.
• Line 102-108: the statement from Aizer et al., 2013 did not support the idea of providing couple counselling in the cancer center.
• There is a lack of linkage between the label "caregiver" with sexuality.
• Line 112-113: I thought the caregiver in this paper only referred to the partner of patients with cancer. Please clarify.
• One question to consider would be to change the labels to impact how people view patients and partners. The more important point here is how we as researchers and clinicians recognize that the dyad experiences cancer together and how to help both of them. However, again, the relationship between labelling and health outcome is not established.
• Line 128-159: it is not clear what does co-supportive means in the context of cancer. Does it mean both dyad members need to support each other? What are the needs? Please clarify. The authors emphasized the importance of supporting partners who may suffer from maladjustment to cancer experience. However, the co-supportive content is missing.
• The spousal caregiver and partner are used exchangeably. Which one do the authors think is more appropriate?
• Where there any other evidence-based strategies besides education and exercise programs about how to support both patient and partner? There is a lack of strategies in helping dyad members to support each other throughout the cancer trajectory. I want the authors to comment on this issue further.
• Line 181-196, again, is sex/gender-based education as efficacious as universal education? Again, please provide more evidence to support the claim.

Author Response

Please see the attachment.

Author Response File: Author Response.docx