Cost Drivers and Financial Burden for Cancer-Affected Families in China: A Systematic Review
Round 1
Reviewer 1 Report
Dear authors, thank you for the present interesting contribution. Here are some suggestions.
- Please, enrich your introduction. It is well-focused on your point of interests; however, it lacks of details about breast cancer patients in general. It could be relevant to provide a paragraph regarding breast cancer patientsì emotions, cognitions, and behaviors.
- Accordingly, it is a mandatory to address Body Image issues. As known, breast cancer patients and survivors access multiple times to hospitals also with the aim to "repair" to some aesthetical appearance problems, which refers to theit body representations.
- Not sure theta your key search terms are sufficient. Please, clarify your choice
- Please, add details about the role of the authors in the process of articles' screening
- Please, add the PRISMA
Some minor typos
Author Response
- Please, enrich your introduction. It is well-focused on your point of interests; however, it lacks of details about breast cancer patients in general. It could be relevant to provide a paragraph regarding breast cancer patients’ emotions, cognitions, and behaviors.
Authors’ response: Thank you for this suggestion. However, this study aimed to explore the financial burden experienced by cancer patients in China, encompassing various cancer types rather than focusing on breast cancer. Thus, we provided an overview of the disease burden caused by cancer, the financial challenges faced by cancer-affected families, and the relevance of healthcare insurance schemes and policies to our research. We appreciate your suggestion and acknowledge the importance of discussing breast cancer patients' emotional experiences, but it is out of the scope of this study. We decided to avoid delving into specific details about any particular cancer, including breast cancer.
- Accordingly, it is a mandatory to address Body Image issues. As known, breast cancer patients and survivors access multiple times to hospitals also with the aim to "repair" to some aesthetical appearance problems, which refers to their body representations.
Authors’ response: Thanks for the comment. We agree that body image is a critical aspect of the overall well-being of cancer-affected individuals, however, the scope and focus of this study was to explore the cost drivers and financial burden experienced by cancer-affected families in China, based on the available published studies. As explained above, we did not focus on a specific cancer. The studies on breast cancer included in this systematic review didn’t investigate the direct and indirect costs associated with the "repair" progress, specifically in the context of breast cancer patients seeking aesthetic procedures to address appearance-related issues. It requires another study with a focus on breast cancer.
- Not sure theta your key search terms are sufficient. Please, clarify your choice.
Authors’ response: The key search terms centered on cancer cost, financial protection schemes and financial burden based on the scope of this study (please see clarification above). We sought assistance from a skilled library specialist to ensure the inclusion of all relevant terms related to our research topic. We provided a full search strategy that encompasses all the search terms utilized for each database in Supplementary File 1, Table S1.
- Please, add details about the role of the authors in the process of articles' screening
Authors’ response: We added the role of the authors in the process of study selection, data extraction and quality assessment of the included studies in the manuscript, 2. Material and Methods_2.1. Eligibility criteria and search strategy (page 2-3).
“We used Covidence to manage all citations and removed duplicates, which facilitated the review of all articles by two independent reviewers. First, YJ, WJ, BY and two trained undergraduate students were paired and independently screened titles and abstracts. Then, YJ, WJ and BY retrieved the full texts for evaluation if a citation was considered relevant or uncertain for inclusion or exclusion due to insufficient information obtained from the title and abstract, extracted data from the included studies, and conducted quality assessments of included studies. A third reviewer (QL) was involved to resolve discrepancies and uncertainties at the selection stage, data extraction and quality assessment.”
- Please, add the PRISMA
Authors’ response: We uploaded the PRISMA checklist and the PRISMA 2020 for Abstract checklist as supplementary files.
Author Response File: 
Author Response.docx
Reviewer 2 Report
The review authors showed that Annual medical costs as a percentage of annual household income ranged from 36.0% to 63.1% with a meta-proportion of 51.0%. Does it address a specific gap in the field? Yes, the topic is interesting and relevant, but it has a narrow focus, assessing only China. The review should not add anything new, it should generalize and systematize existing research. In this case, the authors analyzed the works and discussed them in sufficient detail. What further controls should be considered? The article is well written, my comments relate to the design of tables. the conclusion is consistent with the evidence and arguments presented and they address the main question posed at the beginning. The references are appropriate. Tables 1 and 3 did not fit in width, it is difficult to evaluate them completely. Table 1 is very cumbersome and uninformative, it may make sense to reformulate it, for example, group it by type of cancer. Cost Data Table 2 is best presented as a chart for better comparison.
Author Response
Thank you for your valuable feedback. We modified tables accordingly.
(1) Table 1: We retained main studies characteristics relevant to this study, including the type of cancer, year of study, duration of costs, data source, type of cost reported (mean, median, or both) and cost components in each respective study, given this study’s objective to explore cancer care costs and the financial burden experienced by cancer patients in mainland China, encompassing various cancer types. We had considered sub-group analysis by type of cancer. However, due to the limited number of comparable studies, we are unable to conduct meaningful sub-group analysis. We discussed it as part of the limitations of this study (page 8).
(2) Table 2: We showed the unweighted annual medical costs by subgroups (sex, age, clinical stage, and insurance type) calculated from the four studies listed in Table 2 in bar charts.
(3) Table 3: We reformatted it to show the table on one page.
Author Response File: Author Response.docx
Reviewer 3 Report
The authors present a systematic review study that aims to map the medical, non-medical, and indirect costs incurred by cancer care, as well as the financial burden for patients and their economic coping strategies from 2009 onwards. The study includes 38 original quantitative studies conducted in mainland China.
Comments:
1.
The information regarding Tables 1 and 3 being converted into PDF format in the current version is incomplete. Due to the large size of the Tables, they were cut off during the conversion process, resulting in an incomplete presentation of the Tables.
2.
Table 1 presents a large Table that is not easy to read. It is suggested to simplify it into a more readable version.
3.
It is suggested to conduct a statistical analysis on Table 2 to examine the differences in Annual medical costs between subgroups (e.g., SEX, AGE, etc.) through a difference test.
4.
Table 3 includes nine studies, which may suggest conducting meta-analyses of Annual medical cost as a percentage of annual household income for any tumor.
Author Response
1.The information regarding Tables 1 and 3 being converted into PDF format in the current version is incomplete. Due to the large size of the Tables, they were cut off during the conversion process, resulting in an incomplete presentation of the Tables.
Authors’ response: We reformatted Table 1 and Table 3. Now the contents of two tables are complete.
2.Table 1 presents a large Table that is not easy to read. It is suggested to simplify it into a more readable version.
Authors’ response: Thanks for your comment. We retained main studies characteristics relevant to this study in Table 1, including the type of cancer, year of study, duration of costs, data source, type of cost reported (mean, median, or both) and cost components in each respective study.
3.It is suggested to conduct a statistical analysis on Table 2 to examine the differences in Annual medical costs between subgroups (e.g., SEX, AGE, etc.) through a difference test.
Authors’ response: Thank you for the suggestion. Data presented in Table 2 were from only four studies. The small sample size reduce the power in a difference test. We converted Table 2 to charts, enabling a more intuitive display of the unweighted annual medical costs based on different subgroups (sex, age, clinical stage, insurance type).
4.Table 3 includes nine studies, which may suggest conducting meta-analyses of Annual medical cost as a percentage of annual household income for any tumor.
Authors’ response: Thanks for the suggestion. Only one or two studies reported the cost data for each specific cancer type. We are not able to conduct meta-analyses by type of cancer due to the limited availability of data. We discussed it as part of the limitations of this study (page 8).
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
Thank you for your revisions.
Just another suggestion. In the introduction, I would add a brief paragraph regarding emotionals issues in cancer patients. As known, it is relavant to address cancer-related difficulties. See: Durosini et al., 2022; Reich et al., 2008
References:
- Durosini, I., Triberti, S., Savioni, L., Sebri, V., & Pravettoni, G. (2022). The role of emotion-related abilities in the quality of life of breast cancer survivors: a systematic review. International Journal of Environmental Research and Public Health, 19(19), 12704.
- Reich, M.; Lesur, A.; Perdrizet-Chevallier, C. Depression, Quality of Life and Breast Cancer: A Review of the Literature. Breast Cancer Res. Treat. 2008, 110, 9–17
Minor revisions
Author Response
Thank you for this suggestion. We searched studies investigating the correlation between financial issues and psychological issues, emotional outcomes, and quality of life among cancer patients, and added the information in the manuscript. 1. Introduction (page 2)
Author Response File: Author Response.docx
Reviewer 3 Report
No further comment
Author Response
Many thanks for your previous valuable suggestions to this manuscript!
