Oncology professionals’ perspectives towards cardiac surveillance in breast cancer patients with high cardiotoxicity risk: A qualitative study

Yvonne Koop; Laura Dobbe; Angela H. E. M. Maas; Dick Johan van Spronsen; Femke Atsma; Saloua El Messaoudi; Hester Vermeulen

doi:10.1371/journal.pone.0249067

Peer Review History

Original SubmissionOctober 9, 2020
18 Feb 2021 Decision Letter - Katriina Aalto-Setala, Editor PONE-D-20-31818 Oncology professionals’ perspectives towards cardiac surveillance in breast cancer patients with high cardiotoxicity risk: A qualitative study PLOS ONE Dear Dr. Koop, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The only thing that is a bit of a concern is the size of your study population. It is possible to increase? Please submit your revised manuscript by Apr 04 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Katriina Aalto-Setala, Professor Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. In the methods section, please specify which language the interviews were conducted in, and if necessary, how the transcripts were translated for analysis. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is an important study that investigates attitudes of physicians towards cardiac screening. If detected early, cardiac dysfunction can be treated. The study is well constructed and thoughtful. Concerns: Major - only 12 physicians were interviewed - and only 2 male. This really limits the impact of the study. At least 30 should be surveyed. The manuscript should be edited by someone who is a native speaker of English. Reviewer #2: Manuscript Number: PONE-D-20-31818 Title: Oncology professionals’ perspectives towards cardiac surveillance in breast cancer patients with high cardiotoxicity risk: A qualitative study Reviewer comments This qualitative study about medical oncologist perception regarding cardiac surveillance in breast cancer patients is well written and emphasizes the necessity of guidelines for cardiovascular surveillance after breast cancer treatment. Only comment is regarding the monodisciplinary approach. The manuscript can be strengthened by expanding the group of interviews to cardiologists/specialists in vascular medicine and radiation oncologists. It is not clear why an epidemiologist was included in an interview about clinical practices. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Victoria Seewaldt Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0249067.r001
Revision 1
9 Mar 2021 Author Response Comment 1 reviewer 1 Only 12 physicians were interviewed - and only 2 males. This really limits the impact of the study. At least 30 should be surveyed. Response We thank the reviewer for this comment. We conducted interviews up to the point of data saturation. After the tenth interview, data saturation was reached, which means that no new codes (i.e., no codes that introduced a new topic) were added to the data. We conducted two more interviews to confirm the data saturation. After data saturation was reached, it was deemed methodologically unnecessary to conduct additional interviews because sufficient data had been collected to answer the specific research question. We have revised the methods and results sections to clarify this concern. Methods (P 6, Ln 11-18): Data saturation was defined as the point where additional interviews did not lead to any codes that introduced a new topic, which was reached after ten interviews. Two more interviews confirmed saturation and ensured maximum variation in the sample. After transcribing the interviews, 740 codes were generated and grouped in 32 clusters, such as multidisciplinary collaboration, continuity of care, burden, need for knowledge, urgency, logistics, awareness, personalized care, research, visibility of late cardiac effects, and cost effectiveness. The recurring themes within these clusters were discussed to identify the final themes to answer the research question. The limited variation in gender of the interviewees is a reflection of the gender distribution of breast cancer professionals in general. Most oncology professionals with a specific focus on breast cancer patients are female. To clarify these considerations, we revised the methods section (P 4, Ln 12-13): A purposive sample with maximum variation in gender, work experience, and hospital type was selected with the aim to reflect the true variation in characteristics observed in clinical practice. Comment 2 reviewer 1 The manuscript should be edited by someone who is a native speaker of English. Response The manuscript had been checked by a native speaker before submission to PLOS ONE. Following reviewers’ comments, we asked a second native speaker to edit the manuscript, and any remaining grammatical errors were corrected. Comment 1 reviewer 2 Only comment is regarding the monodisciplinary approach. The manuscript can be strengthened by expanding the group of interviews to cardiologists/specialists in vascular medicine and radiation oncologists. Response We thank the reviewer for this comment, we agree that professionals from cardiology, vascular medicine, and radiotherapy departments could provide additional perspectives on cardiac surveillance. However, with this study, we primarily aimed to explore the perceptions of oncology professionals because they are often the “gatekeepers” for the oncological care trajectories in the Netherlands. Oncologists or oncology nurse practitioners are the first professionals with whom a patient has contact once they are diagnosed with a malignancy. They provide a first draft of a patient’s treatment plan after which the patient is referred to a radiotherapist and surgeon, if indicated. Subsequently, with multidisciplinary discussion and further diagnostic procedures, the treatment plan is finalized. We believe that this would also be an ideal moment for oncologists to assess whether a patient has an increased cardiovascular risk based on their baseline characteristics and the scheduled treatments, and – if indicated – refer the patient to a cardiologist. Additionally, a previous study suggests that, in current practice, patients rarely receive any form of cardiac surveillance. Therefore, we were primarily interested in the perceptions of oncology professionals and potential influencing factors of delivering cardiac surveillance. Comment 2 reviewer 2 It is not clear why an epidemiologist was included in an interview about clinical practices. Response The epidemiologist included in our study is employed at a hospital specialized in oncological care; her work primarily focuses on improving breast cancer care and delivering cardiac surveillance in practice. This participant closely works with oncologists to improve current practice and has a wide knowledge of cardiac surveillance and its influencing factors. Therefore, she was deemed eligible for study participation. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0249067.r002
11 Mar 2021 Decision Letter - Katriina Aalto-Setala, Editor Oncology professionals’ perspectives towards cardiac surveillance in breast cancer patients with high cardiotoxicity risk: A qualitative study PONE-D-20-31818R1 Dear Dr. Koop, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Katriina Aalto-Setala, Professor Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors have addressed all concerns. Their responses are complete. No other concerns. Acceptable for publication. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No https://doi.org/10.1371/journal.pone.0249067.r003
Formally Accepted
22 Mar 2021 Acceptance Letter - Katriina Aalto-Setala, Editor PONE-D-20-31818R1 Oncology professionals’ perspectives towards cardiac surveillance in breast cancer patients with high cardiotoxicity risk: A qualitative study Dear Dr. Koop: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr Katriina Aalto-Setala Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0249067.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .