Screening for Distress and Health Outcomes in Head and Neck Cancer

Round 1

Reviewer 1 Report

Gascon et. al., study's addressed a highly intriguing and crucial problem in HNSCC. This study evaluates the prevalence of emotional distress in HNC across different distress screening measures and investigates whether considerable distress or distress screening is linked to cancer-related survival. The paper is well-written and contains the majority of the important details. There are a few areas that need to be addressed or modified in order to improve the review's quality and attract readers.

- The authors acknowledged developments in surgery and radiation therapy in the Introduction section, but immunotherapy has now become the fourth pillar of solid tumor treatment, therefore it needs to be addressed and explored in the Introduction section.

- It would be nice to know what proportion (percentage) of non-maliganat cases were eliminated from the current study.

- It's fascinating to learn what the general standard deviation (SD) is among the many Distress Assessment and Response Tools (DART)

- Because patients with HNCs are two times more likely to commit suicide than patients with other cancers and four times more likely than the general population, the authors had the opportunity to examine the expression levels of suicide risk genes such as BDNF, COMT, HTT, APH1B, AGBL2, SP110, and SUCLA2.

-It's fascinating to debate and learn how the authors eliminated the potential that patients from diverse ethnic backgrounds would have the same level of distress.

Author Response

Please see attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Head and neck cancers (HNC) reported higher level of emotional distress. Screening for distress can help health care teams to provide appropriate psychosocial care to the patients. The findings of this study are also very meaningful. Here are some suggestions for you:

Introduction

1.The necessity of comparing the prevalence of distress across multiple distress screening measures was not demonstrated in this section.

2. What is the meaning of distress? Some tools are measures of symptoms，depression and anxiety.

3.What is the “standardized screening” in the second paragraph, the explanation should be given.

4. Since the purpose of this study is to compare the prevalence of distress across multiple distress screening measures, why does the author mention and emphasizee DART?

Method

1. The reason why these tools （ESAS-D, ESAS-A, PHQ-9 and GAD-7） were chosen for comparison should be told.
2. For ESAS-D, ESAS-A, PHQ-9 and GAD-7, how do you define the cut-score for none/mild, moderate, moderately severe/severe? Please provide a reference.
3. Why only age, sex, cancer stage, income, and marital status are included as covariates? The confounding factors for cancer-related death are more than these.

RESULT

A general demographic description of the participants should be given in the results.

DISSCUSSION

1. The outcome of this study is cancer-related death. However, in discussion, the author attributed the association of depression and survival to suicide. Is suicide also a cancer-related death?
2. Why did the author discuss anxiety and depression in the fourth and fifth paragraph, and what is the relationship between anxiety, depression and this study?
3. Based on the results, authors can make recommendations on which measurement tools should be used in what kind of scenarios

 

Author Response

Please see attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

Dear authors. I find your work impressive, interesting and beneficial.

Comments:

1. Section 2.3, referal to former presented Aims may be difficult for the reader. I would suggest to mention them again, here
2. Section 2.4, you could consider preparing a Table to sum the many details
3. Table 2: some details whithin the columns need to be straightened
4. Table 3 and others, lack of data regard marrital status, fatherhood/motherhood of more than 70% of population? I think you should try and gather this data. Is it not a part of DART personal data gathering?
5. Table 3, you compared moderate/severe to mild, but under the table you mention only moderate Vs mild 
6. I found out difficult to understand your explanation in regard to a central issue of your fine paper: why are those participants that filled DART questionnaires survived better than those who were not. Especially the fact that the % of stages 3-4 among them were higher ? (Only small % of them seek psychiatric help, eventhough the % is higher than the other group, it could not explain the overall results). I think attention should be made to this issue because your answer does not fully grasp the the gap between the above mentioned clinical status and the outcome, i.e., better long term surviving rates.
7. Conclusion: you mention 16 unpublished papers... conducted by whom, where? when? I would  present those papers in further details

Author Response

Please see attached.

Author Response File: Author Response.docx