PONE-D-19-31377

Does quality of life return to pre-treatment levels five years after curative intent surgery for colorectal cancer? Evidence from the ColoREctal Wellbeing (CREW) study

PLOS ONE

Dear Prof Foster,

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PLOS ONE

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https://doi.org/10.1007/s11764-017-0636-x

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Additional Editor Comments:

Thank you for the submission of the manuscript.

The results are interesting and may contribute to the current knowledge in the field.

Some minor revisions are required.

Please replay to reviewer comments and suggestion.

Sincerely

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

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

Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: In the present very interesting and well-written manuscript, the authors report on the 5-year postoperative course of QOL, as compared to the preoperative status, in a cohort of patients with colorectal cancer (CRC). They have found that at least 25% of them report a worse QOL at all time points of post-surgery follow up. Of the risk factors, aging is weakly associated with worse postoperative QOL, and only among those of 70-80 year-old. Strong preexisting risk factors for worse post-surgery QOL are comorbidities, poor QOL, depression, low levels of self-confidence, and low levels of social support. The authors support the view that some of these factors, as being amenable to change, should be identify by Health Care Professionals at the stage of initial CRC diagnosis for preemptive intervention, support and improvement.

To my opinion some revision is required in order to strengthen the quality of the manuscript:

• The size of the paper is rather lengthy; in particular the sections of “Introduction” and “Discussion”.

• Including colon and rectal cancer in the same entity of CRC does not represent reality. Unlike colon cancer, rectal cancer patients very often receive pre-operative treatment (mostly chemo-radiotherapy), are subjected to an operation with significantly high postoperative morbidity (anastomotic leak), present severe long-term postoperative functional problems (LARS) and some of them carry a permanent stoma. Although the authors report in the section of “Results” that neo-adjuvant treatment is related to worse postoperative QOL, they do not comment the finding in the section of “Discussion”. I would suggest that the impact of rectal cancer surgery on QOL should be reported separately from that of colon cancer, with an emphasis on the LARS syndrome, the anastomotic failure and stoma management, if data are available.

• Similarly it seems worthy that the authors assess the impact of the approach, open or laparoscopic on the post-surgery QOL.

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Reviewer #1: No

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Does quality of life return to pre-treatment levels five years after curative intent surgery for colorectal cancer? Evidence from the ColoREctal Wellbeing (CREW) study

PONE-D-19-31377R1

Dear Dr. Foster,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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With kind regards,

John Souglakos, MD, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: