Research in Perioperative Care of the Cancer Patient: Opportunities and Challenges
Round 1
Reviewer 1 Report
Typo in line 95
Are there any studies showing that these drugs found to affect cancer progression/recurrence still have similar effect outside the context of perioperative anesthesia? For example, line 194-197, if opioid use is truly negatively associated with breast cancer recurrence, such association should be found not only in settings of anesthesia, but in other situations where opioid is used as well. Are there any such studies? If so, would it be helpful to expand the review to include such studies?
Table 2 meant to be “challenges and limitations of randomized control trials”? it says retrospective studies in the title. The point the author made in line 251, design of directional hypothesis, is valid, and this limitation/issue could be added to table 2 as limitation of the study design.
Overall the paper is very well-written and can be accepted with minimal editing/proofreading. The author adopted a more subjective and personal writing style. Given this is a review paper instead of original research, this should be ok.
Author Response
We appreciate this reviewer's comments.
1- Typo in line 95. Answer: This was fixed. "anti-cancer effect"
2- Are there any studies showing that these drugs found to affect cancer progression/recurrence still have similar effect outside the context of perioperative anesthesia? For example, line 194-197, if opioid use is truly negatively associated with breast cancer recurrence, such association should be found not only in settings of anesthesia, but in other situations where opioid is used as well. Are there any such studies? If so, would it be helpful to expand the review to include such studies? Answer: The text was modified. "Another example is a Vijayakumar et al. study in which naltrexone was compared to placebo to evaluate response to therapy in patients with estrogen-positive breast cancer. 27 This study was designed toward a directional hypothesis – positive expected value, and conducted in the non-operative setting, and naltrexone or placebo were given for up to eight weeks. Although an earlier retrospective study suggested that mutations of the opioid receptor could be implicated in breast cancer progression, Vijayakumar’s study demonstrated minimal effect on tumor response as measured by positron emission tomography-computed tomography. 27,28"
3- Table 2 meant to be “challenges and limitations of randomized control trials”? it says retrospective studies in the title. The point the author made in line 251, design of directional hypothesis, is valid, and this limitation/issue could be added to table 2 as limitation of the study design. Answer: The table was modified per this reviewer's recommendation
4- Overall the paper is very well-written and can be accepted with minimal editing/proofreading. The author adopted a more subjective and personal writing style. Given this is a review paper instead of original research, this should be ok. Answer: Thank you for the kind comment.
Reviewer 2 Report
In this manuscript, the authors have attempted to review evidence of anesthetics or analgesics on cancer outcomes and to provide potential research opportunities in the future by comparing basic and clinical research findings. The topic addressed in this manuscript is an important one with direct translational significance and could be of interest to a wide readership in anesthesiology and oncology. The authors also provide new insights based on assimilation/analysis of the extant literature and the manuscript is well written.
Author Response
In this manuscript, the authors have attempted to review evidence of anesthetics or analgesics on cancer outcomes and to provide potential research opportunities in the future by comparing basic and clinical research findings. The topic addressed in this manuscript is an important one with direct translational significance and could be of interest to a wide readership in anesthesiology and oncology. The authors also provide new insights based on assimilation/analysis of the extant literature and the manuscript is well written. Answer: I appreciate the reviewer's comment.
