PONE-D-21-32975Health insurance and financial hardship in cancer survivors during the COVID-19 pandemicPLOS ONE

Dear Dr. Williams,

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Academic Editor

PLOS ONE

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"I have read the journal's policy and the authors of this manuscript have the following competing interests: Dr. Rocque is supported by an American Cancer Society Mentored Research Scholar Grant (MRSG-17-051-01-PCSM) and has received research funding from Genentech, Pfizer, and Carevive and consulting fees for Genentech and Pfizer."

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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

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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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

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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

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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 a well written and important topic on financial burden for cancer patients in the United States during the pandemic. Overall this is a well thought out paper, but I do have a few significant suggestions, and one minor comment.

Significant

1. The authors have made no attempt to identify how the financial impact to patients has changed since the pandemic. I am not suggesting additional analysis, but rather an examination of data pre-pandemic to see if the impact is different (or the same) as it was pre-pandemic in the discussion or limitations.

2. The authors have not addressed the overall impact on employment during the pandemic. Although some federal funding was provided in many cases this would have been a decrease over their regular income stream. Again I am not suggesting additional analysis but at a minimum this needs to be highlighted in the limitations, or an examination of the literature on this topic should be included in the discussion.

Minor

pg 12 of 21 line 122 "which covers may oral..." should read "which covers many oral..."

Reviewer #2: This is a well-written and concise analysis, and it provides a meaningful addition to the growing (and necessary) body of literature on the impact of COVID-19 on cancer patients and survivors. I particularly appreciate your including cost of internet in your survey, as this is, as you note, a potential barrier to telehealth uptake and may limit survivors' ability to engage with other aspects of the healthcare system as well. My comments are minimal but include the following:

1) Please consider omitting your use of "under-resourced" throughout the manuscript, or at least provide a clear definition to understand the research team's characterization of this term.

2) Did you collect any information on time since treatment or diagnosis, or on the respondents' current healthcare use/needs? If so, please report; if not, please note as a limitation, as these factors, particularly current healthcare needs, may influence one's difficulty paying for healthcare use.

3) Please provide more detail on how your outcomes of interest were measured? Were these yes/no questions, or did you use a scale? If the latter, provide detail on how the scale was dichotomized.

4) Was age collected as a continuous variable, or was it collected in the categories reported in Table 1? If the former, consider revising your categorizations more meaningfully to reflect age 65 as the age of Medicare eligibility and 18-39 as the NCI's definition of young adult. Similarly, how was the income threshold of $48K determined?

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Reviewer #1: No

Reviewer #2: No

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Health insurance and financial hardship in cancer survivors during the COVID-19 pandemic

PONE-D-21-32975R1

Dear Dr. Williams,

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.

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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,

Raymond Nienchen Kuo, Ph.D

Academic Editor

PLOS ONE

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

Reviewer #2: All comments have been addressed

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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

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: 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: No

Reviewer #2: Yes

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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

Reviewer #2: 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: I am satisfied with responses from the authors. I have no further questions for the authors. Well done.

Reviewer #2: Thank you for your attention to addressing my previous comments and those of the other reviewer. I have no additional comments.

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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: Yes: Christopher J. Longo

Reviewer #2: No

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