PONE-D-23-41096Identifying Symptom Cluster in Cancer patients undergoing Chemotherapy in Vietnam: a cross-sectional studyPLOS ONE

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PLOS ONE

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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

Reviewer #3: Partly

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

Reviewer #1: I Don't Know

Reviewer #2: Yes

Reviewer #3: 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: No

Reviewer #3: 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: No

Reviewer #3: 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: Thank you for the opportunity to read this manuscript.

This study aimed to assess the prevalence of symptoms experienced by cancer patients during chemotherapy and to identify symptom clusters during chemotherapy in such patients. The research topic is interesting and the manuscript is clearly written. However, there are several issues that need to be addressed. My suggestions are as follows:

Introduction

- Line 60: There should be more than one previous study investigating the symptom clusters in patients receiving chemotherapy. Please elaborate on results of previous studies to justify why this study is needed.

Methods

- Line 77: Please provide more information about the settings of Vietnam to allow reader to understand how representative the sample is. How many large oncology hospitals are there? How many patients do they serve?

- Line 79: Why recruit 20-84 years old? What about 18-19 years old?

- Line 66: Please elaborate on how bed-sharing issues affect the symptom cluster?

- Please provide the ethical approval reference no.

Discussion

- Please provide details on the implications of the study results, given that patients received varying durations, types, and toxicities of chemotherapy.

Reviewer #2: The premise of this study to identify symptom clusters among people undergoing chemotherapy for cancer in Vietnam is significant. Defining the clusters using principal component analysis was appropriate. Several areas warrant consideration, as follows:

1. The statement in the background (page 3, 59-61) that most of the early research measured only 13-15 symptoms is untrue. One of the seminal studies, among others, identified 25 commonly occurring symptoms (PMID: 24797450).

2. The methods section includes a description of the MSAS instrument, including the 3 dimensions the instrument measures. The manuscript reports occurrence and distress related to each symptom but not severity. Either include or justify why this dimension was excluded.

3. It would be helpful develop a table that includes all dimensions being measured and assessed for symptom clusters (e.g., PMID 34560709).

4. Statements such as the sentence on page 12 (lines 253-254) (i.e., “This proves that….”) is inaccurate to state based on one study. This should be rephrased to “The findings suggest….” Or something similar.

5. Overall, the level of grammatical errors and to a lesser degree, spelling errors detracted from the merits of this manuscript. Assistance from an English-speaking scientist is highly recommended.

Overall, this investigation is significant, and merits being reported in the literature. Addressing the above points would strengthen this manuscript tremendously.

Reviewer #3: The manuscript shows the prevalence of symptoms in oncology patients using the MSAS scale in Vietnam. The article is interesting but I have several considerations to mention.

Line 59-61. It cannot be stated that there are no studies assessing this prevalence of 32 symptoms because there are (e.g. doi: 10.3390/ijerph20031708).

There is no sample size calculation.

The inclusion criteria are not clear: as you may know the MSAS assesses the symptoms perceived during the week prior to the chemotherapy session, therefore, patients who are going to receive their first cycle of chemotherapy should not be included since the symptoms they may suffer will not be due to chemotherapy and may represent a bias.

It's been 7 years since the data were collected, are they still representative? haven't they changed even with a pandemic in the middle?

Line 95: "the symptom was measured using a Likert scale from 0 to 4 with a higher score" that is not true, the categories of frequency and intensity are measured from 1 to 4 while distress is measured from 0 to 4 (having 5 possible options).

Is the MSAS scale in Vietnamese validated in oncological patients? Since the only reference I have found is the short version and in HIV patients (10.1080/09540121.2021.1922577)

Line 107-109: these values have to be the reference values in the language in which it is to be used, not in the original.

When were the data collected? Where were they collected? Were they self-completed? Did you go through the MSAS on your own? Did someone help you to fill them in?

Results:

Has any stratified analysis been performed in relation to the sex or age of the participants, even taking into account the type of cancer?

Discussion:

In the introduction they comment that there are no studies with large samples, however, in the discussion reference 23 and 24 contradict this information.

Again, the reference doi: 10.3390/ijerph20031708 should be cited in the text.

Line 209: I am not very clear about the symptom cluster done on the basis of what, prevalence? Could you explain it better, please.

Line 238 “feeling nervour”; line 239 “acitivites.” please correct these words.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Identifying Symptom Cluster in Cancer patients undergoing Chemotherapy in Vietnam: a cross-sectional study

PONE-D-23-41096R1

Dear Dr. Huong Thi Xuan Hoang,

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,

Alison Wang

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

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: (No Response)

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

Reviewer #1: Yes

Reviewer #2: (No Response)

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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

Reviewer #2: (No Response)

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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: (No Response)

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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: Thanks for the revision! It is well-written, and all of my comments were addressed. Thank you very much!

Reviewer #2: (No Response)

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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: No

Reviewer #2: No

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