Reviewer's report
Title:Factors associated with consultation behaviour for primary symptoms
potentially indicating colorectal cancer: A cross-sectional study on response to
symptoms.
Version: 1Date:18 March 2012
Reviewer: Maria Ramos
Reviewer's report:
Major Compulsory Revisions
The main variables: rectal bleeding an change in bowel habit are not well
defined. Rectal bleeding could range from some drops in the toilet paper to the
reddening of all the toilet bowl. Change in bowel habit could include a self-limited
diarrhoea due to a gastroenteritis, but also difficulty in evacuation due to a
colonic mass. In this broad sense, “rectal bleeding” and “change in bowel habit”
are very common symptoms, and it is at least doubtful that they have to be
consulted to the doctor as soon as they appear. I’m not sure that the study
results suggest “a pressing need for identification of symptomatic patients in the
primary care setting” (“The need for intervention in the primary care setting”
section in the Discussion).
As the authors recognize, recall bias has probably affected respondents’
reliability, especially regarding the time taken to seek medical advise. Five years
is a long period to ask someone to specify if he/she has gone to the doctor and
when. Objective verification could have been done reviewing primary health care
clinical records.
Therefore, if the main variables are not well defined, and time intervals collected
from the participants memory, validity of results can be questioned.
Minor Essential Revisions
Background
Survival colorectal cancer information is supported with references of articles
about colorectal mortality (first paragraph).
The statement: “it should be concluded that the public health message should be
to engage in screening for CRC” is too general. This message could be different
in each country depending of the existence or not of a universal public health
system and a population-based screening program.
Results
Description of the clinical and psychological characteristics and predictors of
study respondents variables arre not shown.
Discretionary Revisions
Background
Two systematic reviews were performed and published in European Journal of
Cancer in 2007 and 2008 about the relationship between diagnostic delay and
stage and survival of colorectal cancer. Their results could be taken into account
in the Background section.
A qualitative study exploring factors triggering medical consultation for symptoms
of colorectal cancer and perceptions surrounding diagnosis was published in
Europan Journal of Cancer Care in 2009. Their results could be taken into
account in the Background and Discussion sections.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests'
Reviewer's report
Title:Factors associated with consultation behaviour for primary symptoms
potentially indicating colorectal cancer: A cross-sectional study on response to
symptoms.
Version: 1Date:18 March 2012
Reviewer: Maria Ramos
Reviewer's report:
Major Compulsory Revisions
The main variables: rectal bleeding an change in bowel habit are not well
defined. Rectal bleeding could range from some drops in the toilet paper to the
reddening of all the toilet bowl. Change in bowel habit could include a self-limited
diarrhoea due to a gastroenteritis, but also difficulty in evacuation due to a
colonic mass. In this broad sense, “rectal bleeding” and “change in bowel habit”
are very common symptoms, and it is at least doubtful that they have to be
consulted to the doctor as soon as they appear. I’m not sure that the study
results suggest “a pressing need for identification of symptomatic patients in the
primary care setting” (“The need for intervention in the primary care setting”
section in the Discussion).
As the authors recognize, recall bias has probably affected respondents’
reliability, especially regarding the time taken to seek medical advise. Five years
is a long period to ask someone to specify if he/she has gone to the doctor and
when. Objective verification could have been done reviewing primary health care
clinical records.
Therefore, if the main variables are not well defined, and time intervals collected
from the participants memory, validity of results can be questioned.
Minor Essential Revisions
Background
Survival colorectal cancer information is supported with references of articles
about colorectal mortality (first paragraph).
The statement: “it should be concluded that the public health message should be
to engage in screening for CRC” is too general. This message could be different
in each country depending of the existence or not of a universal public health
system and a population-based screening program.
Results
Description of the clinical and psychological characteristics and predictors of
study respondents variables arre not shown.
Discretionary Revisions
Background
Two systematic reviews were performed and published in European Journal of
Cancer in 2007 and 2008 about the relationship between diagnostic delay and
stage and survival of colorectal cancer. Their results could be taken into account
in the Background section.
A qualitative study exploring factors triggering medical consultation for symptoms
of colorectal cancer and perceptions surrounding diagnosis was published in
Europan Journal of Cancer Care in 2009. Their results could be taken into
account in the Background and Discussion sections.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests'
Please review this paper.
user
Reviewer's report
Title:Factors associated with consultation behaviour for primary symptoms
potentially indicating colorectal cancer: A cross-sectional study on response to
symptoms.
Version: 1Date:18 March 2012
Reviewer: Maria Ramos
Reviewer's report:
Major Compulsory Revisions
The main variables: rectal bleeding an change in bowel habit are not well
defined. Rectal bleeding could range from some drops in the toilet paper to the
reddening of all the toilet bowl. Change in bowel habit could include a self-limited
diarrhoea due to a gastroenteritis, but also difficulty in evacuation due to a
colonic mass. In this broad sense, “rectal bleeding” and “change in bowel habit”
are very common symptoms, and it is at least doubtful that they have to be
consulted to the doctor as soon as they appear. I’m not sure that the study
results suggest “a pressing need for identification of symptomatic patients in the
primary care setting” (“The need for intervention in the primary care setting”
section in the Discussion).
As the authors recognize, recall bias has probably affected respondents’
reliability, especially regarding the time taken to seek medical advise. Five years
is a long period to ask someone to specify if he/she has gone to the doctor and
when. Objective verification could have been done reviewing primary health care
clinical records.
Therefore, if the main variables are not well defined, and time intervals collected
from the participants memory, validity of results can be questioned.
Minor Essential Revisions
Background
Survival colorectal cancer information is supported with references of articles
about colorectal mortality (first paragraph).
The statement: “it should be concluded that the public health message should be
to engage in screening for CRC” is too general. This message could be different
in each country depending of the existence or not of a universal public health
system and a population-based screening program.
Results
Description of the clinical and psychological characteristics and predictors of
study respondents variables arre not shown.
Discretionary Revisions
Background
Two systematic reviews were performed and published in European Journal of
Cancer in 2007 and 2008 about the relationship between diagnostic delay and
stage and survival of colorectal cancer. Their results could be taken into account
in the Background section.
A qualitative study exploring factors triggering medical consultation for symptoms
of colorectal cancer and perceptions surrounding diagnosis was published in
Europan Journal of Cancer Care in 2009. Their results could be taken into
account in the Background and Discussion sections.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests'
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