COVID-19 and Cancer Patients in the Second Year of the Pandemic: Investigating Treatment Impact, Information Sources, and COVID-19-Related Knowledge, Attitudes and Practices

Round 1

Reviewer 1 Report

The study by Ugas et al., led an investigation that examined the effects of the pandemic on cancer patients’ treatment, psychology, knowledge, attitudes, and practices. They adopted an earlier published Method and summarize their descriptive results based on quantitative feedback and tested by regression modelling to explore factors associated with above attributes. Conclusively, authors provided a view of cancer patients perceptions and needs during the COVID-19 pandemic. Overall, it could a report of interest, though more comprehensive information and a structural revision is required.

 

Major issue-

1.            Author better represents their study methodology in the form of a flowchart or a table for comprehensive reporting on that part. Its confusing and difficult to follow the design and drafted objectives of survey.

2.            A section for the study design limitation should be included in the discussion section, it may list the aspects that could be cover in future study and related possibilities.

3.            The key/significant data in the table should be marked (* or underline) to set a distinction.

 

Minor issues-

4.            Please check composition and grammar in the MS, at few places there are inadequacies.

5.            Not sure if authors need to put their qualifications in the author list.

6.            Check the reference format to sync with journal style.

 

7.            Keep response rate value as one- at places it is response rate is 18% instead of 17.8%

Author Response

October 31, 2022

Response to Reviewers

Re: curroncol-1986648, “COVID-19 & Cancer Patients in the Second Year of the Pandemic:
Investigating Treatment Impact, Information Sources, and COVID-19 Related
Knowledge, Attitudes and Practices”

 

Dear Editorial Office,

 

Please find our responses included here:

 

Reviewer #1

 

The study by Ugas et al., led an investigation that examined the effects of the pandemic on cancer patients’ treatment, psychology, knowledge, attitudes, and practices. They adopted an earlier published Method and summarize their descriptive results based on quantitative feedback and tested by regression modelling to explore factors associated with above attributes. Conclusively, authors provided a view of cancer patients perceptions and needs during the COVID-19 pandemic. Overall, it could a report of interest, though more comprehensive information and a structural revision is required.

 

Thank you for taking the time to review our paper. We appreciate the comprehensiveness of your feedback and believe that our changes will result in a higher quality publication and have endeavored to address your concerns below. We’ve used highlighted text to indicate changes in the manuscript that we’ve pasted here for your convenience.

 

Major issue-

 

1. Author better represents their study methodology in the form of a flowchart or a table for comprehensive reporting on that part. Its confusing and difficult to follow the design and drafted objectives of survey.

 

Thank you for your comment. We recognize that the manuscript may be difficult to follow as the survey returned a large amount of data. We think that a flowchart may not be adequate in clearing up any confusion as it would prove difficult in summarizing in a single figure. We have instead included this passage to the Methodology section which we hope provides some clarity. Subheadings were also added to the section to better differentiate the different stages. 

 

The study replicated the methodology used by the authors in an earlier paper [8] by employing a cross-sectional design, with a survey administered to patient participants recruited from a large academic cancer centre in Toronto, Canada. The results of the survey were then used to model relationships between various patient characteristics and outcomes, including knowledge, psychological impact, use of preventative measures, and media sources consumed.

 

2. A section for the study design limitation should be included in the discussion section, it may list the aspects that could be cover in future study and related possibilities.

 

Thank you for your comment. A dedicated section has been added that lists the paper’s limitations. The conclusion suggests areas for future research.

 

4.1 Limitations

Our findings are limited by our well-educated and wealthy population. Pandemic fatigue may also have contributed to a lower response rate compared to the prior version of this study. It is possible that as the pandemic has worn on that patients have adapted to its restrictions or have adjusted their expectations to the reality of the disease. Patients with cancer have reported increased resilience during the pandemic [16]. Participants who were no longer in active treatment were better represented among our participants, and recruitment at an earlier stage in the cancer journey may have produced different results.

 

4.2 Conclusion

This paper provides another snapshot of the state of patients with cancer during the second year of the COVID-19 pandemic. It demonstrates increased optimism among participants in 2021 relative to 2020 that the virus can be controlled and would not disrupt their cancer treatment. These patients continue to demonstrate strong adherence to infection control measures and are knowledgeable about the disease. While vaccine uptake was high, there appears to be significant gaps in information associated with racial minorities, low-income patients, and likely those with low health literacy. Future studies must address the needs of the most disadvantaged patients that are part of a larger segment of society that has been disproportionately affected by the pandemic.

 

 

3. The key/significant data in the table should be marked (* or underline) to set a distinction.

 

Thank you for your comment. The relevant data points have been bolded in the tables so that the reader may identify them more easily. 

 

Minor issues-

4. Please check composition and grammar in the MS, at few places there are inadequacies.

 

Thank you. We apologize for these inadequacies and have gone back to proofread the manuscript and corrected any outstanding errors in grammar, spelling, and punctuation.

 

5. Not sure if authors need to put their qualifications in the author list.

 

Thanks for pointing this out. We have edited the author list to only include our affiliations.

 

6. Check the reference format to sync with journal style.

 

Thank you. We have gone back to ensure that each reference conforms to the specifications laid out by Current Oncology.

 

7. Keep response rate value as one- at places it is response rate is 18% instead of 17.8%

 

Thank for pointing this out. All data points referenced in the manuscript have been rounded to one decimal point for consistency.

Author Response File: Author Response.docx

Reviewer 2 Report

• The primary output/endpoint variable(s)/measurement(s) of the study should be defined.  • Which randomization method was used in the distribution of the individuals included in the study to the groups? 

• Which blinding (masking) method was used in the study? 

• How was the sample size determined? This information should be explained in the Materials and Methods section. 

• Which sampling (probable or non-probable, etc.) method was used in the study?  • Statistical tests for hypothesis testing and their assumptions should be specified in the statistical analysis of the study in the Materials and Methods section.  • The details (version, license number, etc.) of the statistical package(s) or program(s) should be given in the section of "Data Analysis or Statistical Analysis".

Author Response

October 31, 2022

Response to Reviewers

Re: curroncol-1986648, “COVID-19 & Cancer Patients in the Second Year of the Pandemic:
Investigating Treatment Impact, Information Sources, and COVID-19 Related
Knowledge, Attitudes and Practices”

 

Dear Editorial Office,

 

Please find our responses included here:

Reviewer 2

 

• The primary output/endpoint variable(s)/measurement(s) of the study should be defined. 

 

Thank you. We have edited the final paragraph of the introduction section which we hope clarifies this.

 

This study seeks to evaluate the impact of COVID-19 on the psychological well-being and access to cancer health care services of patients with cancer at the end of the fourth wave of the pandemic. It further seeks to investigate their knowledge, attitudes, and practices regarding COVID-19, as well as the sources of information they have consumed. This study seeks to identify predictors, and contrast the results with those found in the first iteration of this survey that was administered in the summer 2020 (between the first and second waves [8]), particularly considering the availability of vaccines against the coronavirus.

 

• Which randomization method was used in the distribution of the individuals included in the study to the groups? 

 

The survey was sent electronically to all patients with a registered email account in the hopes of obtaining the largest possible sample size. We have commented on the demographics of our participant population and the possibility that certain groups were more likely to respond as a limitation to our cross-sectional study.

• Which blinding (masking) method was used in the study? 

Thank you for asking. The survey was sent to patients with a registered email. The results were anonymized prior to data analysis.

• How was the sample size determined? This information should be explained in the Materials and Methods section. 

 

Thank for your response. We did not have a predetermined sample size calculated but instead aimed to garner the largest response possible using the hospital patients with registered emails as a sampling frame.

• Which sampling (probable or non-probable, etc.) method was used in the study? 

A convenience sample was employed to generate the largest possible response rate using every patient with a registered email address. 

• Statistical tests for hypothesis testing and their assumptions should be specified in the statistical analysis of the study in the Materials and Methods section. 

Below we have copied and pasted the existing passages that we believe address these points.

“For continuous outcomes (cancer worry, COVID-19 knowledge, COVID-19 related attitudes, engagement in preventive practices) linear regressions were modelled; model assumptions were checked using plots of standardized residuals and normal Q-Q plots.”

 

And..

“To determine factors associated with use of information sources, multivariable ordinal regression models were fit. The assumption of proportional odds was assessed visually by comparing logit spacing across categories in the manner described by Harrell [12]. Models of continuous variables were assessed using plots of standardized residuals. The Holm-adjusted p-value was calculated to control for multiple testing and holds the type-I error rate for each analysis at 5%.”

 

• The details (version, license number, etc.) of the statistical package(s) or program(s) should be given in the section of "Data Analysis or Statistical Analysis".

Thanks. We have added following information to identify the open-access statistical software used to run our models.

The R statistical programming language was used for all quantitative analysis.

 

 

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

The raised concerns are addressed.