Implementing and Sustaining Early Cancer Diagnosis Initiatives in Canada: An Exploratory Qualitative Study

Round 1

Reviewer 1 Report

The authors have undertaken a comprehensive review of the focus and layout of the paper that has improved it substantially. 

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

I appreciate the authors' adjustments to previous comments. Two minor recommended adjustments:

1. As it appears that the scope of this study is not limited to early cancer diagnosis initiatives of symptomatic patients, suggest adjusting the following line: "We conducted an exploratory qualitative study to explore barriers and facilitators to implementing and sustaining on current initiatives across Canada that optimize early cancer diagnosis for symptomatic patients" to "We conducted an exploratory qualitative study to explore barriers and facilitators to implementing and sustaining current initiatives across Canada that optimize early cancer diagnosis."

2. For the change in line 58-63, suggest adjusting to clarify that "...patients are less likely to be diagnosed with early stage cancer unless they are seen in by their health care provider for cancer screening or for work-up of new symptoms." Suggest deleting the second sentence as it is intuitive to the readership of current oncology that cancer stage is directly related to survival.

Author Response

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Author Response File: Author Response.docx

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

there are several issues with this paper. the first is that it is conceptually weak in terms of establishing the work in the first place. The challenge is that in any improvement effort solutions must be tailored to the problems they are seeking to solve and the lack of specificity in the study design means that there is a lot of information provided that the reader would find it difficult to do anything with. The initiatives are not well described and so even a sense of what is being done in Canada is elusive. Early diagnosis is a challenging concept so understanding the problem more specifically in terms of then matching solutions to the problem is even more hard to follow. There is some really good material in the barriers and facilitators tables that are suggested in the discussion to be the main goal of the paper. Thus I would strongly recommend a complete rework of the paper to be focused not on the environmental scan in total but on the barriers and enablers (including a strong table of the initiatives) and then the capacity to assess if there are and lessons to draw from the findings that would be more useful to the reader. At the moment it would be a bit challenging to take much away that I could use in my context. I have made other comments as comment notes on the attached paper. 

Comments for author File: Comments.pdf

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

Rahim and colleagues have conducted a Canadian-specific environmental scan of current initiatives focused on early cancer diagnosis to identify facilitators and barriers to implementation. This article is well-written and of interest to the broad readership of Current Oncology.

General Comment:

Although this provides a thorough description of the facilitators and barriers to initiative implementation, the scope of the initiatives of interest is not entirely clear. The type of included initiatives in the introduction suggests focus on those which improve time to diagnosis of symptomatic cancers (such as through urgent care clinics, etc); however, the described initiatives in the results suggest a broader scope beyond symptomatic cancers, including screened cancers (ex. line 119-120 as well as throughout results/discussions) and beyond diagnosis (discuss the focus of standardization of surgical triage of one of the included initiatives which suggests cancer treatment, not diagnosis). With this broader scope, I would expect there would be more than 17 initiatives across Canada. Additionally, how initiatives were found to be eligible for inclusion remains unclear. Clarification of these points is important for reader interpretation. A table of the type of initiatives included (or a few examples) would be helpful. 

Introduction:

1. The authors discuss the impact COVID-19 pandemic on patient ambulatory visits or emergency department visits; however, do not discuss the data on how this has translates to impact on cancer patient outcomes. Focusing this on the studied impact on cancer patients would be valuable.

Methods:

1. 2.2 Participants: "Participants were recruited by KT program..." Consider defining KT (not defined earlier.
2. 2.2 Participants: Details on what types of participants were chosen (and why) would be important - were these individuals who were known to have worked in early cancer diagnosis initiatives or a random selection of participants?

Results:

1. 3.1 Participant characteristics: There is an extra comma in the listed provinces in line 112. 
2. 3.2 Initiative characteristics: How were the initiatives chosen for inclusion? As many of these initiatives were in the planning phases, how did you discriminate between an individual's idea and a formal initiative?
3. 3.3.3 Opportunities for early cancer diagnosis...: line 178, consider adjusting "diagnosis imaging" to "diagnostic imaging"

Discussion:

1. "...such as individuals who do not speak English as a second language..." - I think "as a second language" should be removed from this sentence. 

Author Response

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Author Response File: Author Response.docx