Predictors of time to death among cervical cancer patients at Tikur Anbesa specialized hospital from 2014 to 2019: A survival analysis

Benyam Seifu; Chaltu Fikru; Delelegn Yilma; Fasil Tessema

doi:10.1371/journal.pone.0264369

Peer Review History

Original SubmissionFebruary 4, 2021
11 Oct 2021 Decision Letter - James P Brody, Editor PONE-D-21-03938Predictors of time to death among Cervical Cancer patients at Tikur Anbesa Specialized Hospital from 2014 to 2019: A Survival AnalysisPLOS ONE Dear Dr. Seifu, 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. Please consider the external reviewer's comments carefully and use these comments to revise you manuscript. These comments are considered "minor" and your manuscript will be recommended for acceptance after you revise your manuscript. Please submit your revised manuscript by Nov 25 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. 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Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. [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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? 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Reviewer #1: No ****** 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: General comments The study “Predictors of time to death among Cervical Cancer patients at Tikur Anbesa Specialized Hospital from 2014 to 2019: A Survival Analysis” by Seifu and colleagues is interesting and to the literature of cervical cancer in Ethiopia and Africa. However there are few things to consider to improve this manuscript. First the wording and grammar should be improved as it is very difficult to read. I suggest a native speaker to edit this manuscript. Also the introduction is not structured very well and needs to be reworked. The methods could be improved and the discussion should be structured. Below are my comments which should be addressed. Abstract Introduction: Authors should provide the full meaning of any abbreviations at the first use. Authors should write out the full meaning of TASH at first use. The phrase in the objective that indicate that authors assess is wrong. Authors investigated or determined. Access is not the right word to use. Methods: The statement “..sample of 348 patients under follow-up time…” should be rephrased. Authors followed 348 women or a cohort of 348 women. Follow-up time seems vague and not standard. And it is imperative for authors use the phrase “348 patients” rather than a sample of 348 patients. This should be corrected throughout the whole manuscript. The sentence “The data was collected and entered using the android version CS-Entry tool and for the analysis exported to SPSS version 23” should be broken into two and made clear. Just say data was analyzed by SPSS version 23. Authors should keep their sentences simple and clear. Conclusions: The sentences “As the stage of cancer progressed, the chance of surviving gets reduced. Therefore, due emphasis should be given on improving early detection. Routine CC screening programs for high-risk women such as elderly and HIV positive women should be strengthened” should be re written and made more clear and concise. Phrases like “surviving gets reduced” is not scientific and a should be written in a better way. Introduction Line 65- authors should put “early” in front of screening The first paragraph of the introduction is succinctly written and the epidemiology is clearly stated. Therefore, I suggest authors delete their second paragraph as it only elaborately gives the epidemiology of Cervical cancer and adds no new information. It makes the introduction unnecessary long and adds no value besides the manuscript is not focused on the epidemiology of CC. Lines 81-85 already stated in the first paragraph and must not be repeated. Line 89: what is grandmother women? I think all grandmothers are women so no need to add women. Line 95: WHO/ICO must be written in full at first use. Line 103: use Ethiopia rather than “our country” The sentence “Therefore, this study tried to assess the current survival status and predictors of time to death among CC patients in Ethiopia” is confusing. Authors investigated the current survival status and predictors of time to death among CC patients in Ethiopia and did not try to access. I think authors should structure their introduction to make it interesting and reflect on what they seek to find. At present it is just too difficult to read and understand what they seek to do. This is my suggestion - Define cervical cancer, its cause, its risk factors and consequences - Brief epidemiology of cervical cancer worldwide and an emphasis on sub-Saharan Africa and in Ethiopia. - Trends of cervical cancer deaths in Ethiopia, survival status in Ethiopia. - What can be done to prevent deaths and what is the situation in Ethiopia - Review literature on the predictors of time death among women with CC - Rational for the study and the objectives Methods Line 166: remove “which is found”. Line 121 remove “in” in front of from. What is the annual population of patients who received care for CC at TASH? If authors are aware of this then their sample size must be reflective of this figure. Why did authors adopt median survival times in calculating their sample size from a study which reported on clinical trials? This was a cohort study and so authors should explain. What is “Data were collected by two BSc nurses”? please use standard statements. Data were collected by two registered nurses and not BSc nurses. In fact you can even refer to those who collected data as trained research assistants. What is the motivation to use BSc nurses and MSc nurses? Does it communicate anything? Regarding the data collection, it is imperative that authors explain succinctly how they were collected. How were the various Socio-demographic Characteristics and Past Obstetrics and medical history collected and their categorization? Results Line 163: Should read “continuous variables were reported with mean and standard deviations”. Line 181: refuse to participate not were refuse to participate. Line 190 replace whose with who Discussion Line 241: authors did not try but they determined or investigated. First paragraph should briefly summarize the important results of the study. This must be rewritten. Must be checked for grammatical errors by a native speaker. Statements lie “probability of surviving gets slimed” and many other makes it difficult to read the text. ****** 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:** Dan Quansah, PhD. [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.0264369.r001
Revision 1
5 Feb 2022 Author Response Response to Reviewer 1. First the wording and grammar should be improved as it is very difficult to read. I suggest a native speaker to edit this manuscript. First the wording and grammar should be improved as it is very difficult to read. I suggest a native speaker to edit this manuscript. Response: We have tried to correct all the grammatical errors using detailed revision and using online grammar checkers. Also the introduction is not structured very well and needs to be reworked. Response: We have made a revision on Introduction section of the manuscript. 2. Abstract Introduction: Authors should provide the full meaning of any abbreviations at the first use. Authors should write out the full meaning of TASH at first use. The phrase in the objective that indicate that authors assess is wrong. Authors investigated or determined. Access is not the right word to use. Response: The full meaning of abbreviations at the first use is provided. The full meaning of TASH is written at first use as Tikur Anbesa specialized Hospital (TASH) Response: The phrase in the objective that indicates that assess is corrected by investigated as you commented. Methods: The statement “..sample of 348 patients under follow-up time…” should be rephrased. Authors followed 348 women or a cohort of 348 women. Follow-up time seems vague and not standard. And it is imperative for authors use the phrase “348 patients” rather than a sample of 348 patients. This should be corrected throughout the whole manuscript. Response: the phrase a sample of 348 patients is corrected by the phrase “348 patients” throughout the whole manuscript as you suggested The sentence “The data was collected and entered using the android version CS-Entry tool and for the analysis exported to SPSS version 23” should be broken into two and made clear. Just say data was analyzed by SPSS version 23. Authors should keep their sentences simple and clear. Response: The sentence is broken into two and made clear. The data was collected using the android version CS-Entry tool. Data was analyzed by SPSS version 23. Conclusions: The sentences “As the stage of cancer progressed, the chance of surviving gets reduced. Therefore, due emphasis should be given on improving early detection. Routine CC screening programs for high-risk women such as elderly and HIV positive women should be strengthened” should be re written and made more clear and concise. Phrases like “surviving gets reduced” is not scientific and should be written in a better way. Response: Conclusion is rewritten based on the findings in better way. The death rate of CC patients was high. The significant predictors associated with shorten time to death of CC patients were older age, advanced cancer stage at diagnosis, HIV infection and not receiving cancer treatment. Therefore, improving early detection and initiation of treatment for all CC patients is necessary in order to improve patient’s survival status. The government needs to strengthen the routine CC screening programs to address high-risk women such as elderly and HIV positive women in Ethiopia. Introduction Line 65- authors should put “early” in front of screening The first paragraph of the introduction is succinctly written and the epidemiology is clearly stated. Therefore, I suggest authors delete their second paragraph as it only elaborately gives the epidemiology of Cervical cancer and adds no new information. It makes the introduction unnecessary long and adds no value besides the manuscript is not focused on the epidemiology of CC. Lines 81-85 already stated in the first paragraph and must not be repeated. Line 89: what is grandmother women? I think all grandmothers are women so no need to add women. Line 95: WHO/ICO must be written in full at first use. Line 103: use Ethiopia rather than “our country” The sentence “Therefore, this study tried to assess the current survival status and predictors of time to death among CC patients in Ethiopia” is confusing. Authors investigated the current survival status and predictors of time to death among CC patients in Ethiopia and did not try to access. I think authors should structure their introduction to make it interesting and reflect on what they seek to find. At present it is just too difficult to read and understand what they seek to do. This is my suggestion - Define cervical cancer, its cause, its risk factors and consequences - Brief epidemiology of cervical cancer worldwide and an emphasis on sub-Saharan Africa and in Ethiopia. - Trends of cervical cancer deaths in Ethiopia, survival status in Ethiopia. - What can be done to prevent deaths and what is the situation in Ethiopia - Review literature on the predictors of time death among women with CC - Rational for the study and the objectives Response: We agreed with your suggestion to reorganize the introduction section and we have made the necessary adjustments. Through corrections made on Introduction section, we have addressed all of your comments and suggestion. We have marked newly added statements for your kind consideration from line 53-103. Methods Line 166: remove “which is found”. Response: “which is found” is removed as suggested Line 121 remove “in” in front of from Response: “in” is removed as suggested. What is the annual population of patients who received care for CC at TASH? If authors are aware of this then their sample size must be reflective of this figure. Response: We couldn’t get the actual number of the annual population of patients who received care for CC at TASH. But we have tried to show the number of new cases in 2015 ‘In Ethiopia, about 7,095 new CC cases are diagnosed in 2015.’ In the third paragraph of introduction. Why did authors adopt median survival times in calculating their sample size from a study which reported on clinical trials? This was a cohort study and so authors should explain. Response: In calculating the sample size median survival times were taken from previous cohort study conducted in black lion not from clinical trials. The error was made during citing the reference. What is “Data were collected by two BSc nurses”? please use standard statements. Data were collected by two registered nurses and not BSc nurses. In fact you can even refer to those who collected data as trained research assistants. What is the motivation to use BSc nurses and MSc nurses? Does it communicate anything? Response: we corrected the statement as suggested; Data were collected by two registered nurses. BSc nurses are registered nurses. Data collection process was supervised by senior oncology nurse who has master degree on oncology nursing and who have more experience in supervising research data collection and previously participated in research data collection and supervision. Regarding the data collection, it is imperative that authors explain succinctly how they were collected. How were the various Socio-demographic Characteristics and Past Obstetrics and medical history collected and their categorization? Response: the above mentioned information was collected by reviewing the patient card. This information were written in every cancer patient cards based on the standard patient chart prepared by Ethiopian Federal Ministry of Health. Results Line 163: Should read “continuous variables were reported with mean and standard deviations”. Response: the sentence is corrected as suggested, continuous variables were reported with mean and standard deviations Line 181: refuse to participate not Response: were refuse to participate is corrected with refuse to participate as suggested Line 190 replace whose with who Response: whose is replaced with ‘who’ as suggested Discussion Line 241: authors did not try but they determined or investigated. Response: try to assess is corrected with investigated as suggested First paragraph should briefly summarize the important results of the study. This must be rewritten. Must be checked for grammatical errors by a native speaker Response: The important results of the study are briefly summarized in the first paragraph as requested. Statements lie “probability of surviving gets slimed” and many other makes it difficult to read the text. Response: We have tried to correct all the grammatical errors using detailed revision and using online grammar checkers. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0264369.r002
10 Feb 2022 Decision Letter - James P Brody, Editor Predictors of time to death among Cervical Cancer patients at Tikur Anbesa Specialized Hospital from 2014 to 2019: A Survival Analysis PONE-D-21-03938R1 Dear Dr. Seifu, 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, James P Brody Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0264369.r003
Formally Accepted
15 Feb 2022 Acceptance Letter - James P Brody, Editor PONE-D-21-03938R1 Predictors of time to death among cervical cancer patients at Tikur Anbesa specialized hospital from 2014 to 2019: A survival analysis Dear Dr. Seifu: 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. James P Brody Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0264369.r004

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