Dear Dr. Lee,

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.

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ACADEMIC EDITOR:  

Please submit your revised manuscript by Mar 05 2025 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.

• 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 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Ming-Ching Lee

Academic Editor

PLOS ONE

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When submitting your revision, we need you to address these additional requirements.

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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?

Reviewer #1: Partly

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

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: PONE-D-24-32642

Symptom Profiles in Lung Cancer Survivors: A Latent Class Approach

Thank you for asking me to review this paper. The study described is a Latent Class secondary analysis of pre-existing data that sought to classify symptom clusters of lunc=g cancer patients. Four clusters were identified.

The paper addresses an important and current topic in cancer survivorship and care. However, the cross-sectional nature of the study severely limits the conclusions that can be drawn from the work. A second limitation is that the assessments all used the PROMIS system which does not enable comparison with other work in the symptom cluster area of cancer: it is not clear what these assessments actually measure or what their scores indicate in terms of severity or other dimensions. No explanation is given.

There is no information on how the (presumed) subsample of lung cancer patients were derived from the SEER MY-health study, again making interpretation of the results difficult.

The results need to be more clearly presented. There is no information provided on data coding so we do not know what the significant relationship with income means, for example. The referent is > $60K and the ORs are all positive. I’m assuming that the lower income groups have the higher ORs, but it is not discernable from the way the data are presented.

A further problem is that the data are all from the USA, which is an outlier in terms of the costs of the health care system combined with high levels of social problems, and as such does not represent the majority of nations globally. As the social factors are identified as predictors, the results are therefore of limited utility beyond their national boundaries.

Because the data are cross-sectional, the authors are unable to decompose the causal directions for these symptom clusters. It is already well-known that symptoms cluster in cancers. Sleep disturbance may be due to cancer deregulation of circadian function, to anxiety, to pain or, as is often the case, may pre-date the diagnosis and be a lifelong problem. Ditto with depression and we do not know if the pain described is due to cancer, a late-effect of treatment or arthritis, LBP, or other benign conditions. Similarly, low income households are known to report much higher prevalence of depression independent of physical health.

I’m not sure how much this paper actually contributes to further understanding this complex area. However, if the authors can include some caveats regarding the above severe limitations, the data may be of value to U.S. providers.

Reviewer #2: Thank you for the opportunity to review the manuscript entitled "Symptom Profiles in Lung Cancer Survivors: A Latent Class Approach."

Overall, the manuscript covers a critical topic in the cancer continuum, such as survivorship, including this innovative approach regarding symptom management, specifically for lung cancer. It is well-written and original, the methodology seems robust and appropriate, and the results are presented in a clear fashion.

Nevertheless, I have identified minor issues that should be addressed before acceptance. I hope the suggestions and comments enhance the manuscript's clarity and overall impact.

Please see the specific session comments for further details about necessary revisions.

Specific Comments

Abstract: No comments or suggestions

Introduction: No comments or suggestions

Methodology: The authors state that the “Details of the study design, study procedures, and participant descriptions of MY-Health study have been reported elsewhere.” I would request to include the percentage of the 526 individuals represented in the original study and, furthermore, how many lung cancer survivors are estimated in the specific registries and how representative are the included registries considering all registries in SEER database. (page 5)

Results and Discussion: The authors could explore further the limitations regarding the “sample size” representativeness and any biases related to the willingness to participate in the survey. (page 18)

Figures and Tables: Appropriate

Conclusion: No comments or suggestions

Based on my evaluation, I recommend the manuscript for minor revisions before acceptance.

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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.

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Reviewer #1: No

Reviewer #2: No

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[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

Dear Dr. Lee,

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.

Thank you for submitting your manuscript. Please revise your manuscript in accordance with the reviewers' comments and resubmit it for further consideration.

Please submit your revised manuscript by Jul 19 2025 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.

• 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Made Satya Nugraha Gautama, RN, M.Sc.,M.N.Sc

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #3: Partly

**********

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

Reviewer #3: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #3: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #3: No

**********

Reviewer #3:  Please see uploaded document for comments and additional recommendations for revisions. The paper warrants substantial revisions.

**********

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 #3: 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.

Attachments

Attachment

Submitted filename: Plos One review.docx

Symptom Profiles in Lung Cancer Survivors: A Latent Class Approach

PONE-D-24-32642R2

Dear Dr. Lee,

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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Kind regards,

Made Satya Nugraha Gautama, RN, M.Sc.,M.N.Sc

Academic Editor

PLOS ONE