Reviewer ’s report  
 
Title: Quality of life of early stage colorectal cancer patients in Morocco  
 
Version: 0 Date: 24 Feb 2016  
 
Reviewer: Amy Downing  
 
Reviewer's report:  
 
General comments  
 
 
This study looks at the quality of life of early stage colorectal cancer pati ents in Morocco. I 
commend the authors for undertaking this important work but the presentation and clarity of the 
results needs to be improved and there are a number of limitations which need to be addressed.  
 
 
 
1. The manuscript does not explain the reasons for focusing only on early stage patients 
when the data has been collected on all stages.  
 
 
2. The aims of the study are not clear, and are different in the abstract, introduction and the 
'endpoints' section. T he aims in the abstract seem clearer but the paper, as written, does 
not fully address these.  
 
3. Several measurements of QOL were taken but these are not reported. The analysis looks 
at 'baseline' QOL and the final QOL assessment after 12 months.  It is v ery feasible that 
QOL worsened in the months after treatment but had improved again by 12 months, and 
this would explain why some domains were no different between the first and last 
measurements. This is not mentioned anywhere.  
 
4. The 'baseline' measureme nt is not really a baseline because the majority (but exact % 
unknown) of patients have already undergone surgery. The terminology should be 
changed. This is a major limitation because the QOL effects seen could be due to the 
surgery or the subsequent trea tments. The authors need to be mindful of this when 
drawing any conclusions.  
 
5. The results presented focus mainly on the 'baseline' QOL which are described in detail. In 
my opinion it would be better to look at the changes in QOL over time, using more of the 
time points.  
 
 
 
 
Specific comments  
 
 
Abstract  
 
Multicentric - I would use multicentre instead (throughout the manuscript).  
 
The number of patients is stated as 461 but this does not agree with the results (294 early stage).  
 
 
 
Introduction  
 
Line 73: Quality of  life (not live)  
 
Line 80: Revise the aims to be consistent in the abstract and introduction.  
 
 
 
Methods  
 
Line 84: This is repetitive - this information comes in the preceding section.  
 
Line 118 -122: The Endpoints section reads more like aims and could be move d to the end of the 
introduction.  
 
 
 
Results  
 
Why were only early stage patients included? The stage distribution is interesting and the 
majority are stage III (66.3%) which would not really be considered as 'early' stage in the UK or 
US. 
 
When making compari sons between groups it is not always clear what the figures relate to, e.g. 
line 188 and 206 -207. 
 
 
 
Discussion  
 
The discussion tries to make comparisons with other studies but doesn't address the initial aims 
of the study (according to the abstract). This ne eds to be re -written to show what has been found, 
what is new and then do some comparison with the literature.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include  the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to a ssess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering  the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content o f the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any  non-financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agre e to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website alo ng with the authors'  
responses. I agree for my report to be made available under a n Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named repo rt can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Quality of life of early stage colorectal cancer patients in Morocco  
 
Version: 0 Date: 24 Feb 2016  
 
Reviewer: Amy Downing  
 
Reviewer's report:  
 
General comments  
 
 
This study looks at the quality of life of early stage colorectal cancer pati ents in Morocco. I 
commend the authors for undertaking this important work but the presentation and clarity of the 
results needs to be improved and there are a number of limitations which need to be addressed.  
 
 
 
1. The manuscript does not explain the reasons for focusing only on early stage patients 
when the data has been collected on all stages.  
 
 
2. The aims of the study are not clear, and are different in the abstract, introduction and the 
'endpoints' section. T he aims in the abstract seem clearer but the paper, as written, does 
not fully address these.  
 
3. Several measurements of QOL were taken but these are not reported. The analysis looks 
at 'baseline' QOL and the final QOL assessment after 12 months.  It is v ery feasible that 
QOL worsened in the months after treatment but had improved again by 12 months, and 
this would explain why some domains were no different between the first and last 
measurements. This is not mentioned anywhere.  
 
4. The 'baseline' measureme nt is not really a baseline because the majority (but exact % 
unknown) of patients have already undergone surgery. The terminology should be 
changed. This is a major limitation because the QOL effects seen could be due to the 
surgery or the subsequent trea tments. The authors need to be mindful of this when 
drawing any conclusions.  
 
5. The results presented focus mainly on the 'baseline' QOL which are described in detail. In 
my opinion it would be better to look at the changes in QOL over time, using more of the 
time points.  
 
 
 
 
Specific comments  
 
 
Abstract  
 
Multicentric - I would use multicentre instead (throughout the manuscript).  
 
The number of patients is stated as 461 but this does not agree with the results (294 early stage).  
 
 
 
Introduction  
 
Line 73: Quality of  life (not live)  
 
Line 80: Revise the aims to be consistent in the abstract and introduction.  
 
 
 
Methods  
 
Line 84: This is repetitive - this information comes in the preceding section.  
 
Line 118 -122: The Endpoints section reads more like aims and could be move d to the end of the 
introduction.  
 
 
 
Results  
 
Why were only early stage patients included? The stage distribution is interesting and the 
majority are stage III (66.3%) which would not really be considered as 'early' stage in the UK or 
US. 
 
When making compari sons between groups it is not always clear what the figures relate to, e.g. 
line 188 and 206 -207. 
 
 
 
Discussion  
 
The discussion tries to make comparisons with other studies but doesn't address the initial aims 
of the study (according to the abstract). This ne eds to be re -written to show what has been found, 
what is new and then do some comparison with the literature.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include  the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to a ssess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering  the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content o f the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any  non-financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agre e to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website alo ng with the authors'  
responses. I agree for my report to be made available under a n Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named repo rt can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Quality of life of early stage colorectal cancer patients in Morocco  
 
Version: 0 Date: 24 Feb 2016  
 
Reviewer: Amy Downing  
 
Reviewer's report:  
 
General comments  
 
 
This study looks at the quality of life of early stage colorectal cancer pati ents in Morocco. I 
commend the authors for undertaking this important work but the presentation and clarity of the 
results needs to be improved and there are a number of limitations which need to be addressed.  
 
 
 
1. The manuscript does not explain the reasons for focusing only on early stage patients 
when the data has been collected on all stages.  
 
 
2. The aims of the study are not clear, and are different in the abstract, introduction and the 
'endpoints' section. T he aims in the abstract seem clearer but the paper, as written, does 
not fully address these.  
 
3. Several measurements of QOL were taken but these are not reported. The analysis looks 
at 'baseline' QOL and the final QOL assessment after 12 months.  It is v ery feasible that 
QOL worsened in the months after treatment but had improved again by 12 months, and 
this would explain why some domains were no different between the first and last 
measurements. This is not mentioned anywhere.  
 
4. The 'baseline' measureme nt is not really a baseline because the majority (but exact % 
unknown) of patients have already undergone surgery. The terminology should be 
changed. This is a major limitation because the QOL effects seen could be due to the 
surgery or the subsequent trea tments. The authors need to be mindful of this when 
drawing any conclusions.  
 
5. The results presented focus mainly on the 'baseline' QOL which are described in detail. In 
my opinion it would be better to look at the changes in QOL over time, using more of the 
time points.  
 
 
 
 
Specific comments  
 
 
Abstract  
 
Multicentric - I would use multicentre instead (throughout the manuscript).  
 
The number of patients is stated as 461 but this does not agree with the results (294 early stage).  
 
 
 
Introduction  
 
Line 73: Quality of  life (not live)  
 
Line 80: Revise the aims to be consistent in the abstract and introduction.  
 
 
 
Methods  
 
Line 84: This is repetitive - this information comes in the preceding section.  
 
Line 118 -122: The Endpoints section reads more like aims and could be move d to the end of the 
introduction.  
 
 
 
Results  
 
Why were only early stage patients included? The stage distribution is interesting and the 
majority are stage III (66.3%) which would not really be considered as 'early' stage in the UK or 
US. 
 
When making compari sons between groups it is not always clear what the figures relate to, e.g. 
line 188 and 206 -207. 
 
 
 
Discussion  
 
The discussion tries to make comparisons with other studies but doesn't address the initial aims 
of the study (according to the abstract). This ne eds to be re -written to show what has been found, 
what is new and then do some comparison with the literature.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include  the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to a ssess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering  the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content o f the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any  non-financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agre e to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website alo ng with the authors'  
responses. I agree for my report to be made available under a n Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named repo rt can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant