PONE-D-23-12147Gaps in Cancer Care of the multi-ethnic population of Sarawak, BorneoPLOS ONE

Dear Dr. Augustin,

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Academic Editor

PLOS ONE

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Additional Editor Comments:

Dear Authors,

The article has merit and require care full reporting. However, it needs to be improved requiring major review with the comments of both the reviewers. The author have to address the comments to ensure scientific communication while handling the review process.

With regards,

Ranjit

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

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: No

Reviewer #2: Yes

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

Reviewer #1: No

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?

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: 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: This manuscript reports important summary information from a survey focusing on information provided to cancer patients undergoing follow up at the Department of Radiotherapy, Oncology and Palliative Care of the Sarawak General Hospital (SGH) in the state of Sarawak on the island of Borneo in East Malaysia. It has a number of strengths, including a large and diverse sample of participants from an under-studied region, a comprehensive survey about information provision (and participant satisfaction with this), and an assessment of potential discrepancies between self-reported importance of and satisfaction with a number of areas of information provision as part of their cancer care. In spite of these strengths, there are a number of weaknesses that reduce the potential impact of this work.

1) The survey was designed to assess participant satisfaction with, and perceived importance of, a number of aspects relating to the cancer care they were receiving. However, the summaries that are provided for these questions do not appear to address the topic suggested by the title "Gaps in Cancer Care".

2) When summaries are provided for different domains, drastic differences in sample sizes are apparent. It is not completely clear from the methods what leads to these differences (though a partial description is provided in the statistical analysis section). If non-response is purely driven by participants' choices, these differences are informative to what might be concluded from the findings. More attention should be given to this, both from a view focusing on the description of the methods, as well as from a view about the potential for informative non-response. This could provide key and novel insights (e.g. the use of Western-driven domains in a different, non-Western context).

3) It would have been informative had the demographic (and clinical) characteristics of the study participants been compared to reference values (e.g. all cancer patients seen at the medical center, all patients receiving care at the medical center, the population of the state).

4) There are a number of methodological aspects of the manuscript that would benefit from additional information. These include:

a - More information might have been provided relating to the development and validation of the survey. Reporting a range of Chronbach's alpha values for the different (domain-specific?) internal consistencies is not adequate to enable careful assessment.

b - The reported sample size determination does not appear to align with the analyses that are actually reported in this manuscript.

c - It is not clear to this reviewer that a paired t-test comparing "importance" and "satisfaction" scores for specific questions (and domain averages?) is ideal for assessing the degree of agreement between (or differences in) these two areas of interest. Such an approach requires multiple assumptions (including those about comparability of measurement scales), and it is not clear that these were adequately considered or assessed.

d - Subset analyses are reported in the results, but descriptions of the approaches used were not provided.

5) There are a number of reporting practices that could be improved. Some examples include:

a - Summary values for comparisons of interest are often reported without a corresponding measure of variability (see e.g. 177, 178-179, 181, and many more reported comparisons).

b - Figure 1 draws lines connecting the various domains together, yet there is no clear rationale as to why it might make sense to place them on a continuum. Removal of the smoothed lines is likely the most appropriate option here.

c - Figure 1 does not provide measures of variability for the reported "importance" and "satisfaction" means (or, perhaps more appropriately, for the differences between the two means).

Reviewer #2: 1. Development of questionaries mentioned about self administrative. So the authors needs to explain the educational characteristics of respondents in methodology section. As you mentioned the study population is from divers culture. please explain about how the self reporting survey is administrated?

2. The research topic is reflected disparity of cancer care of multi ethnic population in Sarawak. So the data needs to presents details disparity/difference of cancer care gaps within various ethnic population of Swaawak.

3. Discussion should be structured properly and should be more specific to the study. The authors should also discuss what the results of their study imply and cite and discuss more of relevant sources/articles.

4. Please highlight the key inference of the present study in conclusion section.

5. At the end of the discussion, the limitations and suggestions for future studies should be mentioned separately.

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Reviewer #1: Yes: V. Shane Pankratz, Ph.D.

Reviewer #2: No

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Gaps in Cancer Care in a multi-ethnic population in Sarawak, Borneo: A central referral centre study

PONE-D-23-12147R1

Dear Dr. Yolanda Augustin,

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 for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

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,

Ranjit Kumar Dehury

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear authors,

The manuscript has been improved according to the requirements of the journal. Hence, the article is being accepted. However, the authors have to address the minor issues and technical issues in subsequent stages.

With regards,

Ranjit

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)

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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 #2: Yes

Reviewer #3: Yes

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

Reviewer #2: Yes

Reviewer #3: Yes

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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 #2: Yes

Reviewer #3: Yes

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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 #2: Yes

Reviewer #3: Yes

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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 #2: Author have addressed all comment and suggestions. I am glad to review the paper and My best wishes to the authors.

Reviewer #3: Mention the objective in the abstract.

What is financial toxicity?

Line 251: Authors discussing data on subgroup analysis but they did not provide any table in the paper.

There is an anomaly in the line no. 253 [mean(SD) 3.61.6), 3.5(1.5) and 3.3(1.5), respectively].

Line no. 306, give space between 'aspectof'.

Line no. 392, remove extra 'this'.

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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 #2: No

Reviewer #3: Yes: Imteyaz Ahmad

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