Improving the Integration between Palliative Radiotherapy and Supportive Care: A Narrative Review
Round 1
Reviewer 1 Report
Reviewer's report
Manuscript no. Current Onco 1928244
Title: Improving the Integration between Palliative Radiotherapy and Supportive Care: a Narrative Minireview.
Date:2022/9/19
Reviewer's report:
This is an interesting manuscript as it is a complete review of the benefit of the integration beween palliative RT and supportive care. Palliative radiotherapy (PRT) is effective in relieving cancer related symptoms, with few side effects due to the low radiation doses and low treatment-related costs. However, misconception and lack of understanding of radiation therapy causes a barriers hinder the used of PRT. This study gave us a a new perspective on the role of PRT in advance cancers patients. I'm sure this could help in the decision-making process and guide towards an optimal therapeutic strategy for terminally ill cancer patients
The MS is well prepared, method and materials are well explain. Although, there are several limations such as retrospective studies, inhomogeneity of methods and endpoint. However, the study still gave us a strong evidence of the advantage of integrating PRT with supportive care. Therefore, I'm sure this manuscript will add to a growing body of literature aiding the future evaluation and supportive treatment for cancer patient in their last stages of life.. There remain an issues need to be clarified prior publication.
1. what was the radiation dose prescribed in most manuscrupts? Since this is about palliative radiotherapy, it would be more convincing if radiation dose in each studies were written.
Author Response
Comment 1: This is an interesting manuscript as it is a complete review of the benefit of the integration between palliative RT and supportive care. Palliative radiotherapy (PRT) is effective in relieving cancer related symptoms, with few side effects due to the low radiation doses and low treatment-related costs. However, misconception and lack of understanding of radiation therapy causes a barriers hinder the used of PRT. This study gave us a a new perspective on the role of PRT in advance cancers patients. I'm sure this could help in the decision-making process and guide towards an optimal therapeutic strategy for terminally ill cancer patients. The MS is well prepared, method and materials are well explain. Although, there are several limitations such as retrospective studies, inhomogeneity of methods and endpoint. However, the study still gave us a strong evidence of the advantage of integrating PRT with supportive care. Therefore, I'm sure this manuscript will add to a growing body of literature aiding the future evaluation and supportive treatment for cancer patient in their last stages of life.
Answer 1: Dear Reviewer, we have no words to thank you for these positive comments. We really appreciate them.
Comment 2: There remain an issues need to be clarified prior publication. What was the radiation dose prescribed in most manuscripts? Since this is about palliative radiotherapy, it would be more convincing if radiation dose in each studies were written.
Answer 2: Thank you again. Based on your suggestion we added to the “summary and conclusions” section the following sentences: “Moreover, in most analyzed studies no details on dose and fractionation of the PRT were reported. Only Nieder et al., in their comparisons between PRT alone or integrated in multidisciplinary management, reported that PRT was delivered with hypofractionated regimens (from 8 Gy x 1 fraction to 3 Gy x 10 fractions), [24,25] while Ishii et al., in their series of esophageal tumors, used a conventional fractionation (40-60 Gy in 2 Gy/fraction). [32]”
Reviewer 2 Report
Dear editor and dear authors,
Thank you for the opportunity to review your paper entitled “Improving the integration between palliative radiotherapy and supportive care: a Narrative Minireview.”
I appreciated the paper.
The introduction is well framed. I appreciated the methodology, the relation between the results and literature you present in the discussion section, And the summary and conclusions.
Just one doubt, in the methods section, you said 22 papers were included in the narrative review. Please let us know why you just described 19 articles in all the tables.
Thank you
Author Response
Comment 1: Thank you for the opportunity to review your paper entitled “Improving the integration between palliative radiotherapy and supportive care: a Narrative Minireview.” I appreciated the paper. The introduction is well framed. I appreciated the methodology, the relation between the results and literature you present in the discussion section, and the summary and conclusions.
Answer 1: Thank you very much for your positive comments.
Comment 2: Just one doubt, in the methods section, you said 22 papers were included in the narrative review. Please let us know why you just described 19 articles in all the tables.
Answer 2: Thank you again. We realize that this aspect deserves clarification. Therefore we have added at the beginning of paragraph 3.2. the following sentences: “In this paragraph we report on the experiences of integration between PRT and supportive or palliative therapy services. The results are detailed in the second subparagraph and summarized in Table 2a, while the first subparagraph shows, as an introduction to the second, the results of some studies on real world data about what happens when the integration between PRT and supportive therapies is not realized.”
Reviewer 3 Report
This manuscript is a minireview article that summarize information available on improving the palliative radiotherapy (PRT) quality through training and new pathways and organizational models. The authors introduced related articles, which were divided three major parts: (1) Improving PRT, (2) PRT integration with other palliative or supportive treatment, and (3) Educational needs. The authors concluded that all reports uniformly showed clear advantages from integrating PRT with supportive care although the most studies present low levels of evidence.
This study was conducted well, and contained informative information, which will be of interest to researchers and clinicians in the field.
However, the following minor issues require clarification:
Minor
1. (Title) “Article” should be “Review”.
2. (P2L87) “Discussion” should be “Results”.
3. Please clarify the search results: how many literatures were found and how many was excluded by what reasons in detail. Authors may add a figure of the selection tree.
4. Nineteen of 22 included articles are introduced in Tables. Three articles regarding Real world scenarios may not appear in Table. I recommend that the authors also introduce residual 3 articles in Tables.
5. The description regarding two articles written by Nieder C et al. is not seen in the main text. Please describe their findings in the main text.
6. Other findings in the Tables aren’t explained in the main text. Some of them which contains highly suggestive contents should be taken up and explained.
7. The authors described detailed findings in the table and summarize them in the main text. I recommend that the authors should conversely describe detailed findings in the main text and summarize them in the table.
Author Response
Comment 1: This manuscript is a minireview article that summarize information available on improving the palliative radiotherapy (PRT) quality through training and new pathways and organizational models. The authors introduced related articles, which were divided three major parts: (1) Improving PRT, (2) PRT integration with other palliative or supportive treatment, and (3) Educational needs. The authors concluded that all reports uniformly showed clear advantages from integrating PRT with supportive care although the most studies present low levels of evidence. This study was conducted well, and contained informative information, which will be of interest to researchers and clinicians in the field. However, the following minor issues require clarification:
Answer 1: Thank you very much for these positive comments.
Comment 2: (Title) “Article” should be “Review”.
Answer 2: Thank you. The term "review" has been inserted in the current version of the manuscript.
Comment 3: (P2L87) “Discussion” should be “Results”.
Answer 3: Thank you. We modified as suggested.
Comment 4: Please clarify the search results: how many literatures were found and how many was excluded by what reasons in detail. Authors may add a figure of the selection tree.
Answer 4: Thank you for your comment. According to your suggestion we included in the results section (former “discussion” section) the following paragraph: “The initial search on bibliographic databases led to the identification of 188 papers, potentially useful for the purposes of this analysis. The examination of the titles and abstracts led to the selection of 54 papers that were examined in full-text, as 113 papers were found to be irrelevant to the subject of the review, 5 papers were published in a language other than English, and 16 papers were editorial or review. Of the papers evaluated in full-text, 22 were selected and included in this review while 32 papers were considered not relevant to the topic of this analysis.“ Regarding the possibility of inserting a figure showing the selection of literature, as this manuscript is a narrative revision we would prefer to avoid it.
Comment 5: Nineteen of 22 included articles are introduced in Tables. Three articles regarding Real world scenarios may not appear in Table. I recommend that the authors also introduce residual 3 articles in Tables.
Answer 5: Thank you again. We realize that this aspect deserves clarification. Therefore we have added at the beginning of paragraph 3.2. the following sentences: “In this paragraph we report on the experiences of integration between PRT and supportive or palliative therapy services. The results are detailed in the second subparagraph and summarized in Table 2a, while the first subparagraph shows, as an introduction to the second, the results of some studies on real world data about what happens when the integration between PRT and supportive therapies it is not realized.”
Comment 6: The description regarding two articles written by Nieder C et al. is not seen in the main text. Please describe their findings in the main text.
Answer 6: Thank you. According to your suggestion we added to the subparagraph 3.2.2 the following sentences: “Moreover, Nider et al. published the results of two studies comparing patients undergoing PRT alone with subjects managed by a multidisciplinary palliative cancer care team. The first analysis showed that there were no significant differences in survival between the two different types of care. Therefore, the authors concluded that the impact of multidisciplinary palliative care should be investigated prospectively on other relevant endpoints such as symptom control, side effects, and quality of life.[24] Similarly, in the second study, the authors compared patients undergoing PRT as part of normal clinical practice with subjects managed as part of a multidisciplinary palliative care team. Despite the fact that the second group included significantly more patients with reduced performance status and with higher Edmonton symptom assessment system symptom scores (particularly in terms of pain, fatigue, anxiety, and depression), the actuarial overall survival was comparable among the two patients populations and also the rate of PRT during the last month of life was comparable.[25]”
Comment 7: Other findings in the Tables aren’t explained in the main text. Some of them which contains highly suggestive contents should be taken up and explained. The authors described detailed findings in the table and summarize them in the main text. I recommend that the authors should conversely describe detailed findings in the main text and summarize them in the table.
Answer 7: Thank you very much. Actually we agree that some information can be moved from tables into the main text and that some repetitions between text and tables can be eliminated. Therefore, we have removed the "other findings" column from all the tables and inserted the information contained therein within the main text, unless they were already present in it. Please refer to the edited manuscript.
