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Peer-Review Record

Linking Intermediate to Final “Real-World” Outcomes: Is Financial Toxicity a Reliable Predictor of Poorer Outcomes in Cancer?

Curr. Oncol. 2022, 29(4), 2483-2489;
by Christopher J. Longo 1,2
Reviewer 1:
Reviewer 2:
Curr. Oncol. 2022, 29(4), 2483-2489;
Submission received: 3 March 2022 / Revised: 26 March 2022 / Accepted: 30 March 2022 / Published: 2 April 2022

Round 1

Reviewer 1 Report

The main question is addressed by the research of financial toxicity in specific area/region.  It is relevant in the field but it should include more outcomes for the significance of the research. It should analyse and compare at least developed to developing countries studies. Actually, for this review paper, the author should have mentioned what methodology has been used. For a review paper, it should provide more evidence thus references would be included more.

Author Response

1/I have added a note that indicates the examination has focused on developed countries, as feasibility of adoption issues in developing countries are significantly different.

2/The paper now has a description of the rapid review methods along with a PRISMA chart (as Figure 1).   

An overall "response to reviewers" document is also attached.

Author Response File: Author Response.docx

Reviewer 2 Report

Title: Linking intermediate to final “real-world” outcomes: Is financial toxicity a reliable predictor of poorer outcomes in cancer?

I am happy to read this submitted commentary. The Primary objective of this commentary is to provide a rapid review of recent literatures which examine the cost-effectiveness of cancer treatments when incorporating lower income patients whose quality of life, as well as forego or delay care decisions may be influenced by financial toxicity related to their care.

The findings of this manuscript may represent a contribution to this area of literature.

Minor comments

Introduction The exposure to objective financial toxicity, may be widely different to patient groups within countries across different healthcare systems, but subjective financial distress may be equally high across different systems. In this commentary, it may be necessary to clarify and distinguish between relevant literatures which discuss subjective financial toxicity and objective toxicity among cancer patients. In addition, summarize what are impacts of objective financial toxicity, and subjective toxicity on quality of life and overall survival, or forgone/delay cancer care?


Current evidence: 

Is there any empirical literature addressing the impacts of financial toxicity on patients’ mental health outcomes such as depression and anxiety? If yes, perhaps better to include these literature in this commentary.


Literatures on measuring financial toxicities such as  COmprehensive Score for financial Toxicity(Cost) may be added into this commentary. For example,

1. Offodile AC 2nd, Asaad M, Boukovalas S, Bailey C, Lin YL, Teshome M, Greenup RA, Butler C. Financial Toxicity Following Surgical Treatment for Breast Cancer: A Cross-sectional Pilot Study. Ann Surg Oncol. 2021 May;28(5):2451-2462. doi: 10.1245/s10434-020-09216-9. Epub 2020 Oct 13. PMID: 33051742.


2. Durber K, Halkett GK, McMullen M, Nowak AK. Measuring financial toxicity in Australian cancer patients - Validation of the COmprehensive Score for financial Toxicity (FACT COST) measuring financial toxicity in Australian cancer patients. Asia Pac J Clin Oncol. 2021 Aug;17(4):377-387. doi: 10.1111/ajco.13508. Epub 2021 Feb 10. PMID: 33567158.

Future research. Please add more details of models when referring “existing cancer models.” (line 150).  For example, is it possible to include relevant literatures if available?

Discussion.  Discussion is somewhat limited in its suggestions for cancer policy. Suggest addressing literatures on cancer care policy implications of financial toxicity, plus addressing literatures on  “modified economic models”(line 184) that considers financial toxicity of low income patients with various types of cancer, using individual patient data from U.S.  or other countries.

Author Response

Responses to these comments have been addressed in the attached response to reviewers document

Author Response File: Author Response.docx

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