-->PONE-D-25-18997-->-->The impact of cancer therapy-related oral complications on the quality of life and well-being of childhood cancer survivors: A scoping review-->-->PLOS One

Dear Dr. Attaran,

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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We look forward to receiving your revised manuscript.

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Giang Truong Vu, D.D.S., M.S., Ph.D.

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?

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: N/A

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?

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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: Thank you for engaging in this project. In summary, this is an update to a similar review published in 2012 by essentially the same research group. The authors seek to identify broad themes in the area of oral health-related quality life among children with cancer (including adult survivors). Suggestions are as follows:

(1) Abstract

- Include protocol registration

(2) Introduction

- Consider including the number of children living with cancer (preferably w/in the geographic area of the included articles), and the number of adult survivors of childhood cancers

- Line 49: Double-check whether statement "mortality rate continues to decrease" requires some nuance- I suspect this is the case for certain cancers in certain countries (i.e. leukemia in the high-resource countries) but not necessarily for other cancer types and in all resource settings

- Would be helpful to provide very specific ways in which this update differs from the 2012 review

- May want to elaborate more on the types of cancer therapies as how each may impact oral health and subsequently quality of life (for example, children treated for leukemia may have different short and long-term oral health effects of both disease and treatment compared to kids w/ rhabdomyosarcoma)

(2) Materials & Methods

- Line 130 states "In cases of low agreement...reviewers adjusted eligibility criteria until substantial agreement was achieved." This was a bit confusing to me - would be helpful to provide additional context (i.e. whether this is a generally agreed-upon method, how any changes in eligibility criteria were applied across all considered reviews etc.)

(3) Results

- Consider including info about country of origin for each of the studies

- Line 169: Consider summarizing the types of cancers included in this review (i.e. hematologic malignancies, sarcomas etc.) - this would be helpful for the reader to understand prognosis, treatments rendered (and likely oral health effects) etc. that may influence quality of life

(4) Discussion

- May want to use caution when directly comparing results of this review of to the 2012 review, as it is not totally clear (at least to me) whether the methods were exactly the same

- Line 269: May want to elaborate more on long-term challenges among adult survivors of childhood cancer - could briefly discuss what has been found from studies focused on non-oral health effects

- Line 275: May want to mention current professional guidelines (i.e. NCCN guidelines for follow-up care)

(5) Tables & Figures:

Table 1:

- Consider placing this in the supplement and using this space for a summary table of the included studies

Figure 1:

- Include an "n" for each of the excluded reasons

Figure 2:

- Correct spelling and capitalization errors

Table 3:

- May want to report as percentage or similar for comparison and include as a supplement

- Was the OHIP-14 specific to children (citation 12)?

Supplemental Table 1:

- Consistent numbering (between S1 and text) or alphabetizing would be helpful for readers

- Explain n/a (assuming these were multiple cancer types?)

- Broadly, could report this info as a table in the main text

Reviewer #2: Thank you for the opportunity to review the manuscript.

Recommended changes/Modifications-

Keywords:

It is recommended that the keywords be revised to ensure alignment with official MeSH terms, thereby enhancing the indexing and discoverability of your empirical work. For instance, “Cancer treatment” does not appear to be a MeSH term. Additionally, given that the age range of children in the included studies is 0-17 years, the keyword “Children” may not be the most appropriate keyword. “Children” is not a MeSH term as well. Please identify and substitute the closest corresponding MeSH equivalents to maintain consistency with indexing standards.

Abstract:

Line 25: In the Objective section, please consider adding the year of the previous review (e.g. “[2012]”) to clearly indicate that the current review serves as an update to the earlier work.

Line 29: In the Methods section of the abstract, please consider specifying the electronic databases searched and noting that a predefined search strategy was used. If space permits, including the total number of records identified would strengthen the abstract. It would also be helpful to briefly mention the screening software used, that study selection was conducted by two independent reviewers with a third reviewer available to resolve disagreements, and that PRISMA-ScR guidelines were followed.

Line 35: Please include the number of studies in parentheses (e.g., “…a substantial number of studies (XX) reported…”).

Lines 35–36: Consider revising “children self-reported” to “children-reported” for improved clarity and coherence.

Line 38: Consider revising “use of measures of oral health-related quality of life (OHRQoL)…” to “reporting of oral health-related quality of life (OHRQoL) measures has increased” to improve clarity and flow.

Line 39: The current wording could be refined to more precisely reflect how frequently these measures were reported in the included literature. Rephrase “…however they were used in a minority of studies” to “however, they were observed in relatively few studies” or “reported in a limited number of studies.”

Line 40: In the conclusion, consider revising “…growing recognition of the…” to a more action-oriented term (e.g., emphasis, adoption, implementation, or consideration), depending on what is best supported by the findings.

Line 42-44: The phrase “future direction” does not read clearly in this context and would benefit from revision. It is also unclear whether this statement refers to qualitative or mixed-methods assessments of children’s experiences and perceptions of cancer therapy. If this is the intended meaning, please consider revising the sentence to: “Future studies should incorporate qualitative or mixed-methods approaches to capture children’s or parents’ perspectives on cancer therapy, thereby complementing quantitative findings and providing a more comprehensive understanding of the multifaceted impact of oral complications on children’s quality of life.”

Introduction:

The section is well written overall; however, addressing the following points could further strengthen it:

Lines 83–84: Please add a citation to support the statement, “While having the parents’ and health care providers’ perspective is clearly important, it has become evident that children’s perspectives are not always consistent with adults.” In addition, briefly elaborating on how this inconsistency has been demonstrated (e.g., through empirical findings showing discordance between child- and adult-reported outcomes) would strengthen the argument and provide clearer context for readers.

Line 90: The term “trend” may not be appropriate in this context, as the United Nations Convention on the Rights of the Child represents a normative framework or guiding principle rather than an observed trend. Please consider revising the sentence to reflect this distinction.

Line 92: The phrase “…since Noronha and Macdonald’s review up to 2011” may be unclear to readers. For clarity, please consider specifying the publication year of that review (e.g., “published in 2012”).

Lines 93–98: Consider numbering the stated aims of the review. This would help readers more easily align the results and discussion sections with the specific objectives outlined in the Introduction.

Methods:

The Methods section is generally coherent and well organized, with clear subsections and logical flow. Addressing the following points would improve transparency and reproducibility:

Please include a brief description of the PRISMA-ScR framework, including eligibility and exclusion criteria, and the time frame covered by the literature search. While some of this information is mentioned in the abstract, it should be clearly documented within the Methods section itself to ensure methodological completeness.

Results:

The Results section is well drafted overall. The following minor revision would further improve clarity and consistency:

Lines 176–177: The term “well being” should be standardized throughout the manuscript. If a hyphen is used, please ensure consistent usage (e.g., “well-being” or “wellbeing”) across the text.

Discussion:

Overall, the Discussion section is well written and coherent. Addressing the minor points below and providing limited additional development—particularly through clearer contextualization of findings and selective engagement with existing literature—would further strengthen the section.

Line 242: Consider replacing “children’s voices” with “children’s perceptions” to better align with the conceptual framing of the manuscript and maintain academic precision.

Line 245: The term “concern” is vague in this context. Replacing it with “symptoms” would more accurately reflect the subjective experiences being discussed (e.g., pain, emotional distress, social functioning).

Line 254: Please add an appropriate citation to support the description of the assessment tools referenced in this statement.

Line 277: The statement regarding routine oral health assessments would benefit from clarification. Are such assessments not already part of standard pediatric oncology care? Please support this assertion with prior studies and cite evidence-based solutions where available.

Line 278: Please consider revising the sentence “Additionally, psychosocial support should be integrated into care plans…” for clarity and conciseness. In addition, this recommendation should be supported with relevant citations demonstrating the psychosocial impact of visible dental anomalies or disfigurement in pediatric populations.

Lines 283–285: The recommendation for in-depth interviews and participatory research methods may not be feasible for younger children, particularly those aged 0–6 years, and may also raise practical and ethical concerns (e.g., parental consent, cognitive ability to articulate experiences). Please consider revising this recommendation to reflect more age-appropriate qualitative or mixed-methods approaches.

Conclusion:

Line 287: Since the original review was published in 2012, please consider revising “In the last 14 years since the original review” to “In the 13 years since the original review” or “since the last review” for accuracy.

Line 290: Please revise “children’s self-reported symptoms” to “children-reported symptoms” for clarity and consistency.

Lines 297–298: Consider strengthening this statement by explicitly incorporating the role of longitudinal research approaches (as discussed earlier around line 270). This addition would improve coherence between the Discussion and Conclusion sections.

Additional suggestions:

Consider reflecting on any unexpected findings, such as the relative distribution of study designs (e.g., fewer quantitative studies compared with qualitative studies), and discuss possible explanations in the context of existing literature.

Please add a brief statement outlining the strengths and limitations of this scoping review to enhance transparency.

Consider expanding the policy implications by recommending country-level or system-level strategies (e.g., within the Canadian healthcare context) to support standardized data collection, integration of oral health metrics into pediatric oncology care, or inclusion of OHRQoL measures in routine practice. This would strengthen the discussion (Line 273-285)

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Reviewer #1: Yes: Leah I. Leinbach DMD MPH

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Review comments-12.24.25.docx

-->PONE-D-25-18997R1-->-->The impact of cancer therapy-related oral complications on the quality of life and well-being of childhood cancer survivors: A scoping review-->-->PLOS One

Dear Dr. Attaran,

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 May 24 2026 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 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.

As the corresponding author, your ORCID iD is verified in the submission system and will appear in the published article. PLOS supports the use of ORCID, and we encourage all coauthors to register for an ORCID iD and use it as well. Please encourage your coauthors to verify their ORCID iD within the submission system before final acceptance, as unverified ORCID iDs will not appear in the published article. Only  the individual author can complete the verification step; PLOS staff cannot  verify ORCID iDs on behalf of authors.

We look forward to receiving your revised manuscript.

Kind regards,

Giang Vu, D.D.S., M.S., 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 #2: All comments have been addressed

Reviewer #3: (No Response)

**********

-->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 #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #2: Yes

Reviewer #3: N/A

**********

-->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 #2: Yes

Reviewer #3: Yes

**********

-->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 #2: Yes

Reviewer #3: No

**********

-->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 #2: The authors have thoroughly addressed all reviewer comments, and the revisions have significantly strengthened the manuscript. The paper is well-written and clear. I recommend it for publication.

Reviewer #3: Overall, the manuscript has been strengthened since last revision. Below are some minor recommendations:

(1) Introduction: Would be helpful to provide very specific ways in which this update differs from the 2012 review

Thank you for the helpful updates. For additional clarity, I’d suggest including the years in which the cited studies were published, demonstrating changes since 2012. For example, something like “A 2007 study published by Hinds et al highlighted the value of child-focused PROs at end of life...” (Line 107).

(2) Results: Consider including info about country of origin for each of the studies

May want to comment on implications for generalizability in limitations

(3) Table 3. Thank you for the updates. I’d suggest including the date ranges for each study for further clarification. For example, original review (inclusive of years xx-2011 and current review (years 2012-2025).

(4) Supplemental Table 1. Thank you for the additions to this table. You may consider including the citation number from the main text in parentheses – For example, Okello DA article is citation 48 in the main text and 59 in Supplemental Table 1 with 59 in parentheses. In my opinion, would be clearer to have 48 in parentheses with a column heading titled “First Author (main text citation)” or similar

(5) Additional Comments:

Line 45-46: ...“of the importance” extra words?

Line 215-220, 222-224, elsewhere as applicable: Consider adding percentages or number of articles for additional clarity – whichever is chosen, should be consistent throughout paper

Line 252: Do you mean statistical significance and association? If yes, consider reporting how association was measured – if not, consider a different word

Line 297: Did this shift yield different results?

Line 346: “Clear implications for clinical practice” may be too strong given that this was not explicitly analyzed in the review

Minor typographical and punctuation errors should be corrected

**********

-->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 #2: Yes: Bedant Chakraborty

Reviewer #3: Yes: Leah Leinbach

**********

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation.

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-->

Attachments

Attachment

Submitted filename: PONE-D-25-18997_R1 Comments.docx

The impact of cancer therapy-related oral complications on the quality of life and well-being of childhood cancer survivors: A scoping review

PONE-D-25-18997R2

Dear Dr. Attaran,

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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information’ link at the top of the page. For questions related to billing, please contact billing support.

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,

Giang Vu, D.D.S., M.S., 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 #2: All comments have been addressed

Reviewer #3: All comments have been addressed

**********

-->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 #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #2: N/A

Reviewer #3: 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 #2: Yes

Reviewer #3: Yes

**********

-->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 #2: Yes

Reviewer #3: 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 #2: I would like to thank the authors for their careful and thoughtful responses to all reviewer comments. They have done an excellent job addressing the concerns raised during the review process, and the revisions have clearly strengthened the manuscript.

The revised manuscript is thorough, well-written, and coherent. The authors have provided adequate clarification where needed, and the overall presentation and flow of the paper have improved substantially. I appreciate the effort invested in revising the work and in engaging constructively with the reviewers’ feedback.

Overall, I am satisfied with the revisions and have no further comments. I believe the manuscript is now suitable for publication.

Reviewer #3: (No Response)

**********

-->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 #2: No

Reviewer #3: Yes: Leah I. Leinbach DMD MPH

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