Title: Clinical Challenges and Patient Experiences in Early-Onset Colorectal Cancer: Insights
from Seven European Countries
Version: 4 Date: 12 Apr 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-A high level of educational attainment (42 of 47 had university degrees) may limit
generalizability to broader, less educated populations.
-Underrepresentation of patients under 30 (despite being a key risk group) could skew insights
toward older “young adults” (35–49).
-Although participants ranged from Stage II to IV, the data were not stratified by stage, which
may obscure important differences in experiences and care needs.
-Although translation was carefully managed, translation bias is always a risk in qualitative
research. Some emotional nuance may be lost or altered in non-English transcripts.
-Potential cultural expressions may not be fully preserved, despite researchers’ efforts to address
cross-cultural variation.
-Thematic analysis is rich, but no quantitative measures or standardized patient-reported
outcomes were included to complement the qualitative findings.
Limits the ability to compare the severity or prevalence of issues across countries or subgroups.
-While the study discusses systemic healthcare barriers, it lacks a detailed analysis of health
policy structures, budgets, or systemic reforms.
-Policy recommendations are implied, but not fully fleshed out or actionable.
-The discussion could benefit from anchoring in a stronger conceptual or theoretical framework
(e.g., patient-centered care models, and health equity theories).
-This would help connect findings to broader discussions in health policy and public health.
Some repetition across sections (e.g., fatigue and gender issues are revisited multiple times)
could be tightened for better clarity and impact.
-While the study highlights underrepresentation, there’s minimal discussion of socioeconomic,
racial, or ethnic diversity, which could limit the applicability of findings to marginalized
populations.
-While stage-specific differences are acknowledged in the Limitations, the lack of subgroup
analysis (by stage, gender, country) feels like a missed opportunity—especially given the rich
qualitative material.
-The policy recommendations are strong but could be better prioritized (e.g., short-term vs. long-
term interventions) or supported by more specific implementation strategies.
Some claims (like the role of stress or fatigue as a red flag) are intriguing but lack sufficient
empirical backing in this study.
-These should be more clearly flagged as hypotheses or emerging areas rather than firm
conclusions.
Title: Clinical Challenges and Patient Experiences in Early-Onset Colorectal Cancer: Insights
from Seven European Countries
Version: 4 Date: 12 Apr 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-A high level of educational attainment (42 of 47 had university degrees) may limit
generalizability to broader, less educated populations.
-Underrepresentation of patients under 30 (despite being a key risk group) could skew insights
toward older “young adults” (35–49).
-Although participants ranged from Stage II to IV, the data were not stratified by stage, which
may obscure important differences in experiences and care needs.
-Although translation was carefully managed, translation bias is always a risk in qualitative
research. Some emotional nuance may be lost or altered in non-English transcripts.
-Potential cultural expressions may not be fully preserved, despite researchers’ efforts to address
cross-cultural variation.
-Thematic analysis is rich, but no quantitative measures or standardized patient-reported
outcomes were included to complement the qualitative findings.
Limits the ability to compare the severity or prevalence of issues across countries or subgroups.
-While the study discusses systemic healthcare barriers, it lacks a detailed analysis of health
policy structures, budgets, or systemic reforms.
-Policy recommendations are implied, but not fully fleshed out or actionable.
-The discussion could benefit from anchoring in a stronger conceptual or theoretical framework
(e.g., patient-centered care models, and health equity theories).
-This would help connect findings to broader discussions in health policy and public health.
Some repetition across sections (e.g., fatigue and gender issues are revisited multiple times)
could be tightened for better clarity and impact.
-While the study highlights underrepresentation, there’s minimal discussion of socioeconomic,
racial, or ethnic diversity, which could limit the applicability of findings to marginalized
populations.
-While stage-specific differences are acknowledged in the Limitations, the lack of subgroup
analysis (by stage, gender, country) feels like a missed opportunity—especially given the rich
qualitative material.
-The policy recommendations are strong but could be better prioritized (e.g., short-term vs. long-
term interventions) or supported by more specific implementation strategies.
Some claims (like the role of stress or fatigue as a red flag) are intriguing but lack sufficient
empirical backing in this study.
-These should be more clearly flagged as hypotheses or emerging areas rather than firm
conclusions.
Please review this paper.
user
Title: Clinical Challenges and Patient Experiences in Early-Onset Colorectal Cancer: Insights
from Seven European Countries
Version: 4 Date: 12 Apr 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-A high level of educational attainment (42 of 47 had university degrees) may limit
generalizability to broader, less educated populations.
-Underrepresentation of patients under 30 (despite being a key risk group) could skew insights
toward older “young adults” (35–49).
-Although participants ranged from Stage II to IV, the data were not stratified by stage, which
may obscure important differences in experiences and care needs.
-Although translation was carefully managed, translation bias is always a risk in qualitative
research. Some emotional nuance may be lost or altered in non-English transcripts.
-Potential cultural expressions may not be fully preserved, despite researchers’ efforts to address
cross-cultural variation.
-Thematic analysis is rich, but no quantitative measures or standardized patient-reported
outcomes were included to complement the qualitative findings.
Limits the ability to compare the severity or prevalence of issues across countries or subgroups.
-While the study discusses systemic healthcare barriers, it lacks a detailed analysis of health
policy structures, budgets, or systemic reforms.
-Policy recommendations are implied, but not fully fleshed out or actionable.
-The discussion could benefit from anchoring in a stronger conceptual or theoretical framework
(e.g., patient-centered care models, and health equity theories).
-This would help connect findings to broader discussions in health policy and public health.
Some repetition across sections (e.g., fatigue and gender issues are revisited multiple times)
could be tightened for better clarity and impact.
-While the study highlights underrepresentation, there’s minimal discussion of socioeconomic,
racial, or ethnic diversity, which could limit the applicability of findings to marginalized
populations.
-While stage-specific differences are acknowledged in the Limitations, the lack of subgroup
analysis (by stage, gender, country) feels like a missed opportunity—especially given the rich
qualitative material.
-The policy recommendations are strong but could be better prioritized (e.g., short-term vs. long-
term interventions) or supported by more specific implementation strategies.
Some claims (like the role of stress or fatigue as a red flag) are intriguing but lack sufficient
empirical backing in this study.
-These should be more clearly flagged as hypotheses or emerging areas rather than firm
conclusions.
assistant