Assessing the impact of timely diagnosis on psychological outcomes and quality of life for cancer patients: a scoping review

PLOS ONE

Dear Dr. Black,

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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Kind regards,

Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

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?

Reviewer #1: Partly

Reviewer #2: Yes

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

Reviewer #1: N/A

Reviewer #2: N/A

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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: Yes

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: This scoping review addresses an important and under-researched topic: the relationship between timely cancer diagnosis and psychological outcomes or quality of life (QoL) in adult cancer patients. The manuscript is well-structured, adheres to the PRISMA-ScR guidelines, and provides a clear narrative synthesis of the limited evidence available. The authors successfully map the existing literature, identify methodological gaps, and highlight the need for further research. However, there are areas where the manuscript could be strengthened to enhance clarity, rigor, and impact. Below, I provide detailed feedback for revisions.

1. The manuscript notes significant variability in how "timely diagnosis" is defined across studies (e.g., diagnostic intervals, number of pre-referral consultations, patient perceptions). While this heterogeneity is acknowledged, the discussion could be strengthened by explicitly addressing how these differing definitions impact the interpretation of findings. For example, patient-reported perceptions of delay may reflect emotional distress rather than objective time intervals, potentially confounding the association with psychological outcomes.

2. The quality appraisal using the MMAT and Neal et al. criteria is a strength, but the manuscript notes that no study met all Neal et al. criteria, particularly regarding the reporting of event dates (0/6 studies). This is a significant limitation, as precise temporal data are critical for assessing timeliness. The manuscript does not sufficiently explore how this gap affects the reliability of the findings or the feasibility of implementing these criteria in practice.

3. The manuscript briefly mentions socio-demographic characteristics as potential unstudied factors but does not discuss other critical confounders, such as cancer type, stage, treatment intensity, or healthcare system factors (e.g., access to care, referral pathways). These factors could significantly influence both the timeliness of diagnosis and psychological outcomes/QoL.

4. The review identifies a range of psychological outcomes (e.g., QoL, fear of recurrence, distress, coping), but the synthesis does not sufficiently differentiate between short-term (e.g., anxiety during diagnosis) and long-term (e.g., post-treatment distress) outcomes. This distinction is important for public health interventions, as the timing and nature of support may vary.

5. Add a brief analysis in the Results or Discussion that categorizes outcomes by temporal context (e.g., peri-diagnostic vs. survivorship) and discusses implications for intervention design. If the included studies do not provide enough data for this, acknowledge this as a gap.

6. Revise the abstract to briefly clarify the primary sources of heterogeneity (e.g., "varied definitions of timely diagnosis and diverse outcome measures").

7. Provide a complete financial disclosure statement, including author initials, grant numbers, funder names, URLs, and a statement on the funder’s role in the study.

8. "Data Availability Statement" Revise the statement to: "All data underlying the findings are derived from publicly available, peer-reviewed articles referenced in the manuscript and accessible via academic databases."

9. Ensure all references follow PLOS ONE’s style guide, including complete details for web-based sources (e.g., full URL, access date).

10. The manuscript makes a valuable contribution to the literature on timely cancer diagnosis and its psychological impacts. Addressing the major revisions (clarifying timely diagnosis definitions, deepening the quality appraisal discussion, exploring confounders, and differentiating outcome temporality) and minor revisions (improving abstract clarity, and submission requirements) will significantly enhance its rigor and readability. I commend the authors for their thorough approach and look forward to seeing the revised version.

Reviewer #2: The authors have researched a relevant research question exploring the timely diagnosis, psychological outcomes, and QoL in patients with cancer.

More details in the methods section would add value to the manuscript.

Overall English copyediting to avoid syntax errors is recommended.

Following are the detailed comments.

Line 38: dates of events being the least reported – please clarify. The phrase is not clearly understood.

Line 62: than those diagnosed through other routes – please specify the other routes

Lines 107-108: Much is known about the impact of various delays on survival; however, markedly less is known about the other outcomes that affect cancer survivors – please define other outcomes

Line 156: why were Scopus, Web Of Science & Embase databases not included for Literature search?

Line 161: Eligibility criteria – please specify the types of studies included as per study design, time duration (2007-2024?) for which studies were included, geographical location or any other specific inclusion & exclusion criteria that were employed

Line 169-170: did not include adult cancer samples (<18 years) – do you mean adult individuals? – please rephrase for better clarity

Line 187: designed to assess mixed- method research – please provide details/rationale for using mixed methods appraisal tool

How was the quality of studies assessed?

Lines 208-209: Most included studies were cross-sectional survey designs (n=4), with one study being qualitative and one mixed-method design – so did the review include only 6 eligible studies?

Lines 215-216: with one study looking at this cancer only – please specify the type of cancer

Table 1: study characteristics – 1st study, when n=34 – how is the design & analysis reported as case report? Please clarify

Similarly – quantitative case report for study by Robinson 2011 – please clarify the appropriateness of study design

Soomers 2020 – study cannot be both cross-sectional & cohort. Please check

Lines 315-316: Finally, one study used a quantitative definition of three or more pre-referral consultations. – provide details of the definition

Lines 366-367: We analysed six studies containing over 25 types of cancer, with colorectal cancer being the most common in three studies – try to avoid superfluous statements - 3 out 6 is only 50% & it would not be appropriate to say colorectal cancer to be most common.

Line 436: included papers mentioned screening detection – please clarify the meaning of the phrase

To check the uniform reporting & formatting of all references

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Reviewer #1: No

Reviewer #2: No

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Dear Dr. Black,

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 submit your revised manuscript by Oct 04 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 letter that responds to each point raised by the editor, academic editor and reviewers. 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,

Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

PLOS ONE

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

Academic Editor Comments:

• Methods: Mention the specific date when the last literature search was conducted.

• Methods: Description of the identification of records by snowballing from previous studies should be provided in the main text. This is illustrated in the PRISMA flowchart.

• PRISMA flowchart: Mention the specific number of records identified at MEDLINE, CINAHL, and PsycINFO (First box on the left-hand corner of the screen).

• PRISMA flowchart: Cross-check all the numbers provided in this Figure for accuracy.

• Supplementary File 1/Methods: Was the same string of search terms employed in all 3 databases? Related information must be provided in the main text. Besides, the information provided in the Supplementary File 1 lacks clarity.

• Page 20, Line 171, S2_In.Exclusion_Criteria: Indicate “Inclusion & Exclusion Criteria”. Similar corrections should be made elsewhere.

• Supplementary File 2: The presentation of the inclusion and exclusion criteria should be changed. Do not place them side by side in 2 columns. Place the list of exclusion criteria below the list of inclusion criteria, clearly differentiating between the two.

• Page 39: Provide the complete legend/caption/title for the Supplementary Files.

• Supplementary File 5: The footnotes provided should correspond to the information provided in the ‘Checklist’. For example, there seems to be no mention of JBI in the ‘Checklist’.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

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

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

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

Reviewer #1: (No Response)

Reviewer #2: N/A

**********

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

The PLOS Data policy

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

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

Reviewer #1: (No Response)

Reviewer #2: Yes

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Reviewer #1: As per the publication criteria of PLOS One, https://journals.plos.org/plosone/s/criteria-for-publication , the scoping review does not meet the criteria for publication.

Reviewer #2: The reviewer comments have been addressed.

Please Check the following references - reference numbers - 6, 7, 8, 9, 13, 14, 15, 18, 36, 39, 43, 45, 50, 62.

PMID not uniformly reported. Recommended to follow uniform referncing style.

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Reviewer #1: No

Reviewer #2: No

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Assessing the impact of timely diagnosis on psychological outcomes and quality of life for cancer patients: a scoping review

PLOS ONE

Dear Dr. Black,

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 submit your revised manuscript by Dec 07 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.

Please include the following items when submitting your revised manuscript:

• A 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,

Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

PLOS ONE

Journal Requirements:

1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Academic Editor Comments:

The minor comments are addressed by the authors. However, the major issue remains the lack or inconsistency of the definition or explanation for "timely diagnosis" of cancer. The related information put up in Table 1 is confusing and lacks clarity (specifically, the use of phrases like "time since diagnosis" and "ED" in the first row). Make sure to rearrange the order of columns. Besides, club information related to "authors, year of publication, country" in one column, and information on "sample, cancer type, study design, analysis" (follow the same sequence for all the references) in another column. The answers to the question "How have studies conceptualised timely diagnosis?" must be detailed in the text ('results' section). Provide more related information. Include a separate new Table summarizing the findings related to conceptualization of timely diagnosis in the studies that met the inclusion criteria. The related limitations must be further elaborated in the 'limitations' section. In relation to the definition/explanation of/for "timely diagnosis" of cancer, what are the recommendations suggested (by the authors of the present review) to be followed in future studies?

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Assessing the impact of timely diagnosis on psychological outcomes and quality of life for cancer patients: a scoping review

PONE-D-24-59414R3

Dear Dr. Black,

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.

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Kind regards,

Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

PLOS ONE