Waiting Times for Surgery and Radiotherapy Among Breast Cancer Patients in Switzerland: A Cancer Registry-Based Cross-Sectional and Longitudinal Analysis

Response to Reviewer 1

1. Summary

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

2. Questions for General Evaluation

Reviewer’s Evaluation

Response and Revisions

Does the introduction provide sufficient background and include all relevant references?

Can be improved

No adaptations made

Is the research design appropriate?

Yes

No adaptations made

Are the methods adequately described?

Yes

No adaptations made

Are the results clearly presented?

Can be improved

The various sub-sections are now introduced with numbers

Are the conclusions supported by the results?

Are all figures clear and well presented

Must be improved

Can be improved

The conclusion section is adapted

Captures of Figure 3 and Table 5 swapped

3. Point-by-point response to Comments and Suggestions

Comments 1:  Did this study have any inclusion and exclusion criteria?

Response 1: Thank you for pointing this out. Therefore, I have adapted the paragraph "Inclusion criteria" to "Inclusion and exclusion criteria", on page 3, line 107 - 111 with the following content:

Patients included in the analysis were female, age 18 and above, underwent surgery (breast conserving surgery or mastectomy) with curative intent for stage I-III invasive breast cancer. Patients with non-adenocarcinoma, stage IV disease, receiving neoadjuvant/adjuvant chemotherapy, neo-adjuvant hormonal therapy or unknown/palliative therapy were excluded.

Comments 2: Line 334-338: Survival of the cancer patients not only depends on the diagnosis but also depends on treatment regime ? Did the authors considered this?

Response 2: Agree. I have, accordingly, added the following sentence on page 13, section “Results”, line 341 – 342, and on page 16, paragraph "Strength and limitations of the study", line 538 - 540:

…, tumor stage and other treatment regimens (endocrine therapy, chemotherapy, anti-HER2, and anti-CDK4/6 therapies) were not analysed as confounders for OS.

Comments 3: What about the patients who had a) secondary cancers or b) diagnosed with advanced disease condition?

Response 3: Thank you for pointing this out.

a) We did not consider secondary cancers before or after the diagnosis of breast cancer for this analysis. Therefore, I have included this issue in the discussion, paragraph "Strengths and limitations of the study", page 16, line 544 – 545:

…, secondary cancers diagnosed before or after breast cancer were not considered,…

b) Additionally, I included the exclusion of stage IV disease in the paragraph "Inclusion and exclusion criteria", page 3, line 109-110:

Patients with non-adenocarcinoma, stage IV disease, receiving neoadjuvant/adjuvant chemotherapy, neo-adjuvant hormonal therapy or unknown/palliative therapy were ex-cluded.

Comments 4: Does the timeline for surgery depends on patient conditions? ( includes but not limited to travel, making appointment, financial or insurance)?

Response 4: Thank you for pointing this out. Therefore, I have added the following passage in the paragraph "Strengths and limitations of the study", page 16, line 542 – 544:

Furthermore, data on performance status, potentially reflecting travel capacity, and financial status were unavailable; however, insurance status (private vs. public) may approximate financial status.

Response to Reviewer 2

1. Summary

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions highlighted/in track changes in the re-submitted files.

2. Questions for General Evaluation

Reviewer’s Evaluation

Response and Revisions

Does the introduction provide sufficient background and include all relevant references?

Yes

No adaptations made

Is the research design appropriate?

Can be improved

No adaptations made

Are the methods adequately described?

Yes

No adaptations made

Are the results clearly presented?

Can be improved

The various sub-sections are now introduced with numbers

Are the conclusions supported by the results?

Are all figures and tables clear and well presented

Yes

Can be improved

No adaptations made

Captures of Figure 3 and Table 5 swapped

3. Point-by-point response to Comments and Suggestions

The manuscript, entitled "Waiting times for surgery and radiotherapy among breast cancer patients in Switzerland: A Cancer Registry-Based Cross Sectional and Longitudinal Analysis", publishes the results of a study of the time during which breast cancer patients receive medical care, including diagnosis, surgery and chemotherapy. The article is of great practical importance, since successful cancer treatment requires accurate scientific data on how much time doctors have in reserve. The authors conducted a statistical analysis and compared the time of patient care with their mortality, and also added comparative data from a significant number of literary sources. The text is written competently; the narration is consistent. The conclusions are supported by the results, but the results can be a little more specific. The graphic design needs to be improved. Perhaps it would be clearer if the authors had drawn a graphic abstract. It is recommended to accept the article without minor formal changes.

Thank you very much for your positive and supportive feedback. As suggested, I have created a graphical abstract that visually summarizes the article in a clearer and more engaging way. I hope this addition enhances the overall presentation and accessibility of the study.

Comments 1: Chapters 2 and 3 should preferably be structured by numbering the sub-chapters, for example, 2.1, 2.2, and so on. The title should not be separated from the text of the chapter (line 86).

Response 1: Thank you for pointing this out. As recommended, I have numbered the subchapters and adjusted the formatting so that the text now follows directly after each subtitle. I trust this revision aligns with your formatting requirements.

Comments 2: The font of the figures and tables differs from the font of the main text of the article. The caption to table 5 is located in the wrong place. Tables 2 and 5 are overloaded with data that is difficult to perceive. Perhaps it would be necessary to reduce the amount of information in these tables.

Response 2: Thank you very much for pointing this out. I agree. I have, accordingly, adjusted the font style in Tables 2–6 for consistency and condensed the Tables 2 and 5 to reduce visual overload and improve readability. The captions of Table 5 and Figure 3 have also been corrected and swapped.

Thank you for your comment regarding the font style of the figures. I kindly ask the journal team to assist with adapting the fonts during the production process. Alternatively, I would appreciate a bit more time to consult with our statistician to make the necessary adjustments, if preferred.

Comments 3: In Chapter 5, it is desirable to provide the final numerical values of the research results.

Response 2: I fully agree with your suggestion. Accordingly, I have now included the final numerical values of the research findings to enhance clarity and completeness.