Title: Clinical Challenges and Patient Experiences in Early-Onset Colorectal Cancer: Insights
from Seven European Countries
Version: 3 Date: 25 Mar 2025
Reviewer's report:
Weaknesses and Limitations
Sample and Generalizability:
Small sample size (n=47) limits statistical power and representativeness. Recruitment via patient
organizations may introduce selection bias (e.g., overrepresentation of educated, advocacy-
aware participants).
Methodological Gaps:
Lack of standardized protocols for focus groups (e.g., mixed languages, varying facilitators)
risks inconsistent data collection.
Absence of inter-coder reliability measures in thematic analysis raises questions about
interpretive rigor.
Ethical Oversight Concerns:
While NHS REC approval was not required in the UK, the manuscript does not clarify
compliance with ethics regulations in other EU countries (e.g., Ireland’s HSE framework).
Reliance on internal board approval may not meet all national standards for human-subject
research.
Funding and Conflicts of Interest:
Funding from pharmaceutical companies (Bayer, BMS, Daiichi Sankyo) is disclosed, but the
lack of competing interests statement warrants caution. Industry involvement, even indirect,
could influence study framing (e.g., emphasis on biomarkers/testing).
Data Limitations:
Qualitative focus restricts quantitative analysis of prevalence (e.g., diagnostic delay duration,
biomarker testing rates).
References to future publications (e.g., 2024–2025 studies) as supporting evidence weaken the
literature review’s credibility.
Recommendations for Improvement
Expand Sample Diversity:
Include participants from underrepresented demographics (e.g., lower education levels, rural
areas) to enhance generalizability.
Strengthen Methodology:
Standardize focus group protocols (e.g., uniform language, facilitator training) and employ
mixed-methods approaches for triangulation.
Report inter-coder reliability and reflexivity in thematic analysis.
Address Ethical Gaps:
Clarify compliance with ethics frameworks in all participating countries (e.g., Ireland’s HSE
requirements, EU GDPR for health data).
Deepen Implementation Strategies:
Provide concrete steps for proposed interventions (e.g., how to integrate gender-sensitive
training into medical curricula).
Explore cost-benefit analyses for lowering screening ages, a key policy recommendation.
Mitigate Funding Bias:
Include explicit safeguards in future studies to ensure industry sponsors do not influence research
design or outcomes.
Title: Clinical Challenges and Patient Experiences in Early-Onset Colorectal Cancer: Insights
from Seven European Countries
Version: 3 Date: 25 Mar 2025
Reviewer's report:
Weaknesses and Limitations
Sample and Generalizability:
Small sample size (n=47) limits statistical power and representativeness. Recruitment via patient
organizations may introduce selection bias (e.g., overrepresentation of educated, advocacy-
aware participants).
Methodological Gaps:
Lack of standardized protocols for focus groups (e.g., mixed languages, varying facilitators)
risks inconsistent data collection.
Absence of inter-coder reliability measures in thematic analysis raises questions about
interpretive rigor.
Ethical Oversight Concerns:
While NHS REC approval was not required in the UK, the manuscript does not clarify
compliance with ethics regulations in other EU countries (e.g., Ireland’s HSE framework).
Reliance on internal board approval may not meet all national standards for human-subject
research.
Funding and Conflicts of Interest:
Funding from pharmaceutical companies (Bayer, BMS, Daiichi Sankyo) is disclosed, but the
lack of competing interests statement warrants caution. Industry involvement, even indirect,
could influence study framing (e.g., emphasis on biomarkers/testing).
Data Limitations:
Qualitative focus restricts quantitative analysis of prevalence (e.g., diagnostic delay duration,
biomarker testing rates).
References to future publications (e.g., 2024–2025 studies) as supporting evidence weaken the
literature review’s credibility.
Recommendations for Improvement
Expand Sample Diversity:
Include participants from underrepresented demographics (e.g., lower education levels, rural
areas) to enhance generalizability.
Strengthen Methodology:
Standardize focus group protocols (e.g., uniform language, facilitator training) and employ
mixed-methods approaches for triangulation.
Report inter-coder reliability and reflexivity in thematic analysis.
Address Ethical Gaps:
Clarify compliance with ethics frameworks in all participating countries (e.g., Ireland’s HSE
requirements, EU GDPR for health data).
Deepen Implementation Strategies:
Provide concrete steps for proposed interventions (e.g., how to integrate gender-sensitive
training into medical curricula).
Explore cost-benefit analyses for lowering screening ages, a key policy recommendation.
Mitigate Funding Bias:
Include explicit safeguards in future studies to ensure industry sponsors do not influence research
design or outcomes.
Please review this paper.
user
Title: Clinical Challenges and Patient Experiences in Early-Onset Colorectal Cancer: Insights
from Seven European Countries
Version: 3 Date: 25 Mar 2025
Reviewer's report:
Weaknesses and Limitations
Sample and Generalizability:
Small sample size (n=47) limits statistical power and representativeness. Recruitment via patient
organizations may introduce selection bias (e.g., overrepresentation of educated, advocacy-
aware participants).
Methodological Gaps:
Lack of standardized protocols for focus groups (e.g., mixed languages, varying facilitators)
risks inconsistent data collection.
Absence of inter-coder reliability measures in thematic analysis raises questions about
interpretive rigor.
Ethical Oversight Concerns:
While NHS REC approval was not required in the UK, the manuscript does not clarify
compliance with ethics regulations in other EU countries (e.g., Ireland’s HSE framework).
Reliance on internal board approval may not meet all national standards for human-subject
research.
Funding and Conflicts of Interest:
Funding from pharmaceutical companies (Bayer, BMS, Daiichi Sankyo) is disclosed, but the
lack of competing interests statement warrants caution. Industry involvement, even indirect,
could influence study framing (e.g., emphasis on biomarkers/testing).
Data Limitations:
Qualitative focus restricts quantitative analysis of prevalence (e.g., diagnostic delay duration,
biomarker testing rates).
References to future publications (e.g., 2024–2025 studies) as supporting evidence weaken the
literature review’s credibility.
Recommendations for Improvement
Expand Sample Diversity:
Include participants from underrepresented demographics (e.g., lower education levels, rural
areas) to enhance generalizability.
Strengthen Methodology:
Standardize focus group protocols (e.g., uniform language, facilitator training) and employ
mixed-methods approaches for triangulation.
Report inter-coder reliability and reflexivity in thematic analysis.
Address Ethical Gaps:
Clarify compliance with ethics frameworks in all participating countries (e.g., Ireland’s HSE
requirements, EU GDPR for health data).
Deepen Implementation Strategies:
Provide concrete steps for proposed interventions (e.g., how to integrate gender-sensitive
training into medical curricula).
Explore cost-benefit analyses for lowering screening ages, a key policy recommendation.
Mitigate Funding Bias:
Include explicit safeguards in future studies to ensure industry sponsors do not influence research
design or outcomes.
assistant