Quality of Life and Psychological Distress Related to Fertility and Pregnancy in AYAs Treated for Gynecological Cancer: A Systematic Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Quality of life and survival issue are both important area in treating cancer patients. In addition, fertility is non-negotiable topic in women’s cancer especially in her reproductive period.

I have minor suggestion.

1.    What’s boundary, guideline and chance for gynecologic cancer in terms of fertility-Staging I, II, III, IV, Is it impossible among advanced case? Or recurrent cases? Is there fertility sparing radiation indication? How’s uterus transplantation after hysterectomy? Do we adopt more aggressive chemotherapy cystectomy instead of oophorectomy, hysteroscopic resection instead of hysterectomy, wide conization or trachelectomy instead of hysterectomy? How’s future teratogenic effect of conventional chemotherapy and target treatment? How’s bad survival because of delayed treatment due to ovary function preservation?

2.    What’s the chance of successful normal pregnancy rate among healthy person compared to GY/other cancer patients? How’s assisted reproductive method for improving pregnancy rate? How much is needed for oocyte preservation and success rate? Do all patients need a psychologic consult for seriousness of fertility & survival?

3.    Relatively minor endometrial cancer population (15%) compared to study population of USA (7) and Europe (3). Is there more option for Increasing AYA endometrial cancer in western world? How’s fertility value difference among ethnicity (Asian vs Western) or physician/hospital choice bias difference (More aggressive physician vs non-aggressive, fertility supporting facility affiliated vs non)?           

Comments on the Quality of English Language

Not much

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The authors conducted a systematic review on psychological distress in AYAs with gynecological cancer.

They included 15 manuscripts. Please mention the publication period of these manuscripts also in the abstracts.

The presentation of the results is not at all mature and a Table 1 reaching from page 5-15 with columns that comprise 2 words are simply inacceptable.

Since AYAs can be aged from 15 to 46 years, an information that is painfully missing is how many persons had already children before their cancer diagnosis and how many were nonparous and also how many women became pregnant and gave birth to a healthy child after their cancer treatment.

The views on fertility preservation are obviously different for adolescents and for a woman in her thirties and moreover forties.... This should be taken into account and reported and discussed in all paragraphs

Comments on the Quality of English Language

for me ok

Author Response

Please see the attachment. 

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The quality and the readability have been considerably improved - no further issues for me