The Experience of Mindfulness-Based Stress Reduction on Menopausal Symptoms, Sleep Disturbance, and Body Image among Patients with Breast Cancer—A Qualitative Study

Round 1

Reviewer 1 Report

Introduction:

1) Line 41 to 43 needs more explanation, for example how can it lead to domestic violence?

2) Line 78: Best not to simply state that your research is important, explain how is it important - i.e. the merits that this research brings and how it advances this field of study.

3) The specific objectives of this study needs to be mentioned, Line 80 to 83 only roughly says what the research does.

 

Materials and method:

2.3.1

1) Why were the participants divided into three focus groups? Even the discussion and results doesn't mention the significance  of each group, the findings are  described as a whole.

2) Line 123: Remove “if” - ...were homogeneous, as they were all...

 

Results:

1) Its understandable that this study is qualitative in nature, but some qualitative data would better explain the significance of this study. For instance stating the exact number of participants agrees or disagrees with a view. (Example: 13 or 50% of participants agree that mindfulness intervention were beneficial to them). Also, some in-depth analyses after including the respondents responses would significantly improve the quality of the paper i.e. what can be interpreted from these specific responses.

3.1.1

1) How many participants actually experienced sleep disturbance and how many were from damaged lymph nodes or blood vessels?

3.1.2
1) How many in this study experienced negative body image and sexual problems? Is it similar to that of the international literature? If no, why?

3.2.1
1) How many forgot to practice and how did this impact the study overall? How was it overcome?

3.2.2
1) How did they respond differently? General explanation of the differences is needed.

2) Line 263: How "young" is younger? why do they experience more stress?

3.3.2
1) How many is "most"? How many preferred meditation and body scanning? Were there other techniques that were preferred by others?

Discussion:
1) Line 383 onwards: If insomnia is caused by damaged lymph nodes and blood vessels, how can MBSR intervention address this and improve sleep quality?

 

Conclusion:
1) Conclusion is not sufficient, it just summarizes what was done in the study. Provide key takeaways of the study and its significant findings. It should make readers understand what your study achieves and how they can utilize its findings in this field or for future studies.

 

 

 

Author Response

Title:

The Experience of Mindfulness-Based Stress Reduction on Menopausal Symptoms, Sleep Disturbance, and Body Image Among Patients with Breast Cancer-A Qualitative Study

The kind and constructive comments and suggestions from the reviewers are highly appreciated. We have included your important comments and questions and carefully revised the manuscript. All text revisions were tracked in the revised draft using the revision tracking feature. In the following are your comments (shown italics) and our detailed response (shown bold).

In the following are your comments and our detailed response.

Reply to Reviewers’ Comments

 

Introduction:

• Line 41 to 43 needs more explanation, for example how can it lead to domestic violence?

Response：We appreciate the helpful suggestion provided by the reviewer. We've explained a lot. (Line 45 to 47)

 

• Line 78: Best not to simply state that your research is important, explain how is it important - i.e. the merits that this research brings and how it advances this field of study.

Response：Our research is important because it helps to fill a gap in the current literature on positive body image in women with breast cancer [18]. Despite the increasing attention given to this topic in recent years, existing research on the subject has largely concentrated on therapeutic approaches [19], with a limited focus on the impact of mindful-ness-based stress reduction (MBSR) interventions specifically. Our study, in contrast, aims to fill this gap by specifically exploring the effects of MBSR on sleep quality and emotional well-being, providing a more comprehensive understanding of this field. Our study illuminates the experiences and perspectives of women with breast cancer, providing valuable insights that can inform the development of clinical practices that aim to improve the quality of life for individuals affected by this disease. Through this research, we aim to contribute to the ongoing efforts to advance breast cancer care and enhance the outcomes for those impacted by this illness. (Line 88 to 99)

3) The specific objectives of this study needs to be mentioned, Line 80 to 83 only roughly says what the research does.

 Response：Our research is important because it helps to fill a gap in the current literature on positive body image in women with breast cancer [18]. Despite the increasing attention given to this topic in recent years, existing research on the subject has largely concentrated on therapeutic approaches [19], with a limited focus on the impact of mindful-ness-based stress reduction (MBSR) interventions specifically. Our study, in contrast, aims to fill this gap by specifically exploring the effects of MBSR on sleep quality and emotional well-being, providing a more comprehensive understanding of this field. Our study illuminates the experiences and perspectives of women with breast cancer, providing valuable insights that can inform the development of clinical practices that aim to improve the quality of life for individuals affected by this disease. Through this research, we aim to contribute to the ongoing efforts to advance breast cancer care and enhance the outcomes for those impacted by this illness. (Line 88 to 99)

Materials and method:

2.3.1

1) Why were the participants divided into three focus groups? Even the discussion and results doesn't mention the significance of each group, the findings are described as a whole.

Response：The participants in the study were divided into three focus groups. First, the researchers wanted to gather data from a diverse group of participants in order to gain a more comprehensive understanding of the experiences and perspectives of women with breast cancer. By dividing the participants into three focus groups, the researchers may have been able to gather data from a larger and more diverse sample of participants. Second, typically, a focus group consists of between 6 and 8 participants [1]. In general, a smaller group size can facilitate more in-depth discussion and allow for more detailed feedback from each participant. However, it's important to make sure that the group size is not too large. Too many people can make it difficult for everyone to speak and be heard, which can lead to group dynamics that are difficult to manage, or discourage individual from speaking.

[REFERENCE]

1. Bloor, M., Focus groups in social research. 2001: Sage.

 

2) Line 123: Remove “if” - ...were homogeneous, as they were all...

Response：We have deleted according to the reviewer's recommendations and restructured the sentence. (Line 165 to 170)

 

Results:

1) Its understandable that this study is qualitative in nature, but some qualitative data would better explain the significance of this study. For instance stating the exact number of participants agrees or disagrees with a view. (Example: 13 or 50% of participants agree that mindfulness intervention were beneficial to them). Also, some in-depth analyses after including the respondents responses would significantly improve the quality of the paper i.e. what can be interpreted from these specific responses.
Response：We appreciate the helpful suggestion provided by the reviewer. We've added as follows: Of the participants, 76.9% of whom were patients with breast cancer living a fast-paced lifestyle, reported that the mindfulness intervention was beneficial to them after attending a series of sessions. (Line 362 to 363)

 

3.1.1

1) How many participants actually experienced sleep disturbance and how many were from damaged lymph nodes or blood vessels?

Response：The following are the changes we made: Out of the participants we included, approximately 19.2% had experienced damage to their lymph nodes or blood vessels. One patient reported the following: (Line 254 to 255)

Hormonal therapy can cause side effects such as menopausal symptoms, including hot flashes, night sweats, and frequent urination. Specifically, 25% of the patients reported that their sleep quality worsened after undergoing hormonal therapy. Three patients said the following: (Line 261 to 265)

 

 

 

 

3.1.2
1) How many in this study experienced negative body image and sexual problems? Is it similar to that of the international literature? If no, why?

Response：However, only two participants in our study reported experiencing the above problem. Possible reasons for this could include the fact that East Asian women tend to be relatively conservative when it comes to discussing sexual issues, as well as the fact that the interview mode used was a focus group format, which may have made participants feel uncomfortable discussing this issue in front of others [6]. As one woman stated: (Line288 to 293)

3.2.1
1) How many forgot to practice and how did this impact the study overall? How was it overcome?

Response：Therefore, approximately 2 participants reported frequently forgetting to practice mindfulness techniques. As a result, they would make up for it by practicing the techniques the following day. (Line 423 to 425)

3.2.2
1) How did they respond differently? General explanation of the differences is needed.

Response：We have rephrased to make our article more understandable to readers. The following is the rephrased paragraph: In general, it's possible that some participants may have found the mindfulness techniques more beneficial than others, or that they may have had different levels of engagement or adherence to the intervention. Some participants may have had a better response to certain techniques, such as meditation or yoga, while others may have found other techniques, such as body scan or mindful eating, to be more effective. Additionally, participants may have varied in their overall well-being, general mental health, coping abilities or even the stage of cancer, which could affect the level of benefit they experienced. (Line 320 to 328)

2) Line 263: How "young" is younger? why do they experience more stress?

Response：We have revised the wording to "parents with children" and cited relevant literature. (Line 282 to 283)

 

 

3.3.2
1) How many is "most"? How many preferred meditation and body scanning? Were there other techniques that were preferred by others?

Response：We appreciate the helpful suggestion provided by the reviewer. We've added as follows: Approximately 90% of patients frequently have complex thoughts. Participants chose mindfulness techniques that suited them. Core mindfulness techniques, such as meditation and body scan, were the most popular, with a preference rate of 80.8% and 73.1% respectively. Other participants preferred techniques such as yoga and mindful eating, which have positive effects on the psychological well-being of breast cancer patients. Additionally, mindfulness practice is not limited by location and can be practiced at home or in other places such as hospitals. Two attendees stated the following: (Line 388 to 394)

Discussion:
1) Line 383 onwards: If insomnia is caused by damaged lymph nodes and blood vessels, how can MBSR intervention address this and improve sleep quality?

Response：We have added the “1.1. Mindfulness mechanism” in the introduction in order to explain why mindfulness can improve physical and psychological issues in patients with breast cancer. (Line 98 to 123)

 

Conclusion:
1) Conclusion is not sufficient, it just summarizes what was done in the study. Provide key takeaways of the study and its significant findings. It should make readers understand what your study achieves and how they can utilize its findings in this field or for future studies.

Response：We have revised the conclusion. The modified conclusion is as follows:

"Our study aimed to understand the benefits of Mindfulness-Based Stress Reduction (MBSR) from the point of view of breast cancer patients, how it affected their mental and physical distress, and how they perceived the skills they acquired from MBSR. Through this research, we sought to offer a holistic, non-pharmacological approach to improving the well-being of breast cancer patients. The findings of our study can be used by healthcare professionals and researchers to understand the potential benefits of MBSR for breast cancer patients, and to implement similar interventions in their own practices or studies. Furthermore, patients with breast cancer can gain insight about how MBSR skills can help them to cope with the challenges of their condition, especially in distress and mental well-being." (Line 473 to 485)

 

 

We tried our best to improve the manuscript and made some changes in the manuscript. These changes will not influence the content and framework of the paper. And here we marked in red in the revised paper.

We appreciate for Editors/Reviewers’ warm work earnestly, and hope that the correction will meet with approval.

Once again, thank you very much for your comments and suggestions.

 

Author Response File: Author Response.pdf

Reviewer 2 Report

A better understanding of menopausal symptoms, body image, and sleep problems in breast cancer patients is essential to improve their health and survival. Therefore, the topic of this study is critical. 

However, since this is a qualitative study, authors must avoid drawing causal conclusions on the effectiveness of MBRS in their sample. In particular, they must thoroughly search for and downtone all the causal statements in the manuscripts starting from the abstract (i.e., This study identified the short-term effect of group-based 28 MBSR experienced by women with breast cancer), e.g., substituting the "it has an effect" statements with an "it is associated to". Furthermore, authors must define a "focus group" for readers who do not know what it is. 

Moreover, the authors must expand the limitation section, better highlighting the boundaries of a qualitative study, such as the absence of control groups and quantitive measurements and the tiny sample, which questions the generalizability of subjective reports. 

Finally, I suggest citing in the introduction a recent paper that is highly relevant to sustain the role of MBRS in the female population exposed to unpredictable health risks, such as covid (PMID: 34063864).  

Author Response

Title:

The Experience of Mindfulness-Based Stress Reduction on Menopausal Symptoms, Sleep Disturbance, and Body Image Among Patients with Breast Cancer-A Qualitative Study

The kind and constructive comments and suggestions from the reviewers are highly appreciated. We have included your important comments and questions and carefully revised the manuscript. All text revisions were tracked in the revised draft using the revision tracking feature. In the following are your comments (shown italics) and our detailed response (shown bold).

In the following are your comments and our detailed response.

Reply to Reviewers’ Comments

 

A better understanding of menopausal symptoms, body image, and sleep problems in breast cancer patients is essential to improve their health and survival. Therefore, the topic of this study is critical.

 

However, since this is a qualitative study, authors must avoid drawing causal conclusions on the effectiveness of MBRS in their sample. In particular, they must thoroughly search for and downtone all the causal statements in the manuscripts starting from the abstract (i.e., This study identified the short-term effect of group-based 28 MBSR experienced by women with breast cancer), e.g., substituting the "it has an effect" statements with an "it is associated to". Furthermore, authors must define a "focus group" for readers who do not know what it is.

Response：We appreciate the helpful suggestion provided by the reviewer. The modified sentence is as follows: This study identified the short-term benefits associated with group-based MBSR for women with breast cancer. (Line 28 to 30)

 

Moreover, the authors must expand the limitation section, better highlighting the boundaries of a qualitative study, such as the absence of control groups and quantitative measurements and the tiny sample, which questions the generalizability of subjective reports.

 

Response：The present study has several limitations that must be acknowledged. One limitation is that qualitative data analysis can be subjective. While themes were chosen based on scientific analysis, they were still somewhat affected by the researchers' involvement. To produce more objective and complete results, future research should include objective physical tests as indicators. Another limitation is the absence of control groups and quantitative measurements, which raises concerns about the generalizability of the study's subjective reports. Additionally, the small sample size also raises questions about the generalizability of the findings to a larger population. (Line 452 to 464)

 

Finally, I suggest citing in the introduction a recent paper that is highly relevant to sustain the role of MBRS in the female population exposed to unpredictable health risks, such as covid (PMID: 34063864). 

Response：We have included the reference that the reviewer suggested. (Line 69 to 71)

 

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

The authors satisfactorily implemented the changes requested.