Barriers and Unequal Access to Timely Molecular Testing Results: Addressing the Inequities in Cancer Care Delays across Canada

Round 1

Reviewer 1 Report

It was a pleasure to review this interesting report on a conference held to focus on challenges and opportunities for change related to equitable and timely access to biomarker testing in Canada. The authors did an excellent job positioning the importance of the conference, describing attendees and their various contributions, and reporting learnings and recommendations from the conference. The manuscript is a well-written synthesis. I have no recommendations for revisions. 

Author Response

Thank you for your positive review.

Reviewer 2 Report

This paper describes the results of a conference, which are interesting to read. However, it is unclear if the statements are just opinions of opinion leaders or if there is any systematic scientific evidence available confirming the statements. I think it should be made much clearer how the stements were generated and if they can be confirmed by research like small area analyses.

Abstract:

Line 36: «a Canadian conference brought together leaders across different tumour types” : personally I find “leaders across different tumour types”  a strange expression, where there tumours coming together? What about “a Canadian conference brought together leading experts in the field of different tumour types”

Also, this whole sentence is extremely long from line 34 to 39. Maybe try to make two out of it. The same for the second sentence in the abstract.

3. Why is Timely Access to Molecular Testing Results an Imperative in Canada?

In this part (line 100-122) a lot is stated without any references, are these just claims without scientific evidence? Please provide references if available.

Line 145: “than patients from Montreal [13] Data from the United”: a “.” Is missing after [13]

Table 1 and 4.3. Lack of patient education and awareness of genomic medicine options: I just wonder as a patient, when I’am diagnosed with a cancer should I already be aware of genomic medicine options? That physicians are not aware of these options is bad news, but as a patient I trust that my physician can inform me about such options? Maybe one can discuss this point a bit?

Between line 242 and 243 the letter type size increases until line 249

General:

·         Some statements are repeated in different chapters in the manuscript. Maybe try to reduce these repetitions.

·         What was the method used to identify challenges and opportunities? Were the experts only discussing or was there a formal methodology. How were all these statements generated. Just collected personal opinion/experience of the experts or a group process (Delphi?) formulating a common opinion of the problem?

·         Is there evidence on the statements for example generated by small area analyses?

Author Response

This paper describes the results of a conference, which are interesting to read. However, it is unclear if the statements are just opinions of opinion leaders or if there is any systematic scientific evidence available confirming the statements. I think it should be made much clearer how the statements were generated and if they can be confirmed by research like small area analyses.

Abstract:

Line 36: «a Canadian conference brought together leaders across different tumour types” : personally, I find “leaders across different tumour types”  a strange expression, where their tumours coming together? What about “a Canadian conference brought together leading experts in the field of different tumour types”

Also, this whole sentence is extremely long from line 34 to 39. Maybe try to make two out of it. The same for the second sentence in the abstract.

Response: Edited to read as follows: In 2023, a Canadian conference brought together leaders with expertise in different tumour types. The objective was to identify challenges and opportunities for change in terms of equitable and timely access to biomarker testing and reporting at the education, delivery, laboratory, patient and health system levels in Canada.

3. Why is Timely Access to Molecular Testing Results an Imperative in Canada?

In this part (line 100-122) a lot is stated without any references, are these just claims without scientific evidence? Please provide references if available.

Response: Appropriate references have been added throughout this this section, and subsequent references renumbered in the text and reference list.

Line 145: “than patients from Montreal [13] Data from the United”: a “.” Is missing after [13]

Response: Amended

Table 1 and 4.3. Lack of patient education and awareness of genomic medicine options: I just wonder as a patient, when I’m diagnosed with a cancer should I already be aware of genomic medicine options? That physicians are not aware of these options is bad news, but as a patient I trust that my physician can inform me about such options? Maybe one can discuss this point a bit?

Response: Extra sentences have been added to section 4.3 to discuss that it is the issues with physician knowledge and lack of discussion around biomarkers addressed in the previous sections 4.1 and 4.2 that leave some patients in the situation of having to seek out information on their own.

Between line 242 and 243 the letter type size increases until line 249

Response: Amended.

General:

• Some statements are repeated in different chapters in the manuscript. Maybe try to reduce these repetitions.

Response: The repetition was deliberate in order to highlight commonalities across the tumour types, provinces and specialties.

• What was the method used to identify challenges and opportunities? Were the experts only discussing or was there a formal methodology. How were all these statements generated. Just collected personal opinion/experience of the experts or a group process (Delphi?) formulating a common opinion of the problem?

Response: As indicated in the text, this was an online conference hosted by CCRAN. Invited experts from patient advocacy groups, physicians and patients were invited to share their expertise and experience accessing biomarking testing. Appendix 1 provides the full conference agenda. The full recording of the conference is available for any reader who might be interested in listening to the presentations and ensuing discussions. The recommendations were distilled from a review of the content presented by experts during the conference and review of the discussions held during each session. No formal process such as a Delphi methodology was employed during the conference. This information has been added to section 2.1 to ensure that the methodology is clear to readers.

• Is there evidence on the statements for example generated by small area analyses?

Response: The presentations that were given by experts during each session made appropriate references to the relevant evidence.  These references have been included throughout the text when the content from the presentation was included in the summary paper.

Reviewer 3 Report

A very well written and extremely important paper with up to date information and a potential large clinical impact. It addresses a serious problem

I have no criticism or comments- except that for a pathologist like me I should appreciate a more detailed information on recommended technologies to achieve the goals and preferably a list of commercial solutions to perform the analytical testing - but that could be the content of the next paper from the authors

Author Response

Thank you for your positive review and for your suggestion for a subsequent paper directed at pathologists.