Diagnostic Performance of Screening Tools for Depressive Symptoms in Vulnerable Older Patients with Cancer Undergoing Comprehensive Geriatric Assessment (CGA): Results from the SCREEN Pilot Study
, Ann-Sophie Maenhoudt 3, Lore Ketelaars 3, Jolien De Zutter 3, Stefanie Pinson 3, Laura Keunebrock 3, Lorenz Haaker 1, Kathleen Deckmyn 1, Mathilde Gheysen 1, Cindy Kenis 4,5, Hans Wildiers 4, Laurence Depoorter 6, Pieter-Jan Geerts 7, Rebecca Chandler 8, Tom Boterberg 2, Patricia Schofield 9, Christopher N. Parris 10 and Philip R. Debruyne 1,9,10,*
Lorinda A Coombs
Round 1
Reviewer 1 Report
To the Authors,
Thank you for the opportunity to review your work. While this is an important area of study, and for the most part was well designed, there are several issues I think need to be addressed.
1. The language in the introduction could be improved. “It causes serious suffering” should be edited to Depression causes serious suffering and distress, ….” (line 51 page 2)
2. Run on sentence Line 51-55.
3. Depression is not necessarily undetected, but perhaps assessment is under-utilized. (page 2 line 57)
4. Perhaps the authors could provide detail on the rationale behind choosing the GDS-4, PHQ-9 and PHQ-2 for comparison with the SCID-5-S? (They provide a clear statement on why the GDS-15 was chosen with the NCCN statement.)
5. Please provide support for the statement that depressive symptoms may differ substantially between patients in a curative versus palliative setting? If all stages were included, why were patients receiving palliative care excluded? (Many metastatic diseases have prolonged survival with immunotherapy).
6. Also, on page 4, line 199 the authors state that 2 participants wished to stop all treatment and were excluded—why was that an exclusion and that she be stated clearly in inclusion and exclusion criteria. A limitation of the study would be that they were only able to screen patients who were coming to the day clinic.
7. In Table 1, the authors mention a clear example of explicit bias across sexes--If a standard scale is not assessed appropriately across all participants, then it should not be included or only included for the 5 items assessed across both sexes. It is inappropriate to include statements regarding responsibilities that are “only applicable to women”.
8. Page 3 Data Collection—please elaborate on how often patients’ symptoms of depression were assessed.
9. Discussion section
In the explanation of study design, the authors need to be more transparent around why participants were excluded, stating that “Treatment intent was not an inclusion criteria, although many would only receive follow-up and could not be included to practical reasons” is not an explanation and belongs in the study methodology section, not the discussion.
10. Explicitly state the percentage of participants who had stage IV instead of a majority (page 9 line 305).
11. Interestingly, the authors have not discussed the impact of impact of COVID-19 on the mental wellbeing of older adults with cancer, which should be recognized as a factor in the discussion.
12. Again, the language in the discussion section needs to edited to improve grammar, i.e. “meaning you are not missing out on anyone…” (Line 327)
13. The discussion section needs to be rewritten for succinctness and accuracy.
14. The references are quite outdated for the most part, and would benefit from a review of the literature.
Author Response
Please see attachment
Author Response File: 
Author Response.docx
Reviewer 2 Report
The authors adequately present the problem addressed by the work, perhaps they should extend the citations or references to previous works that address this same topic. The results are clearly presented, exhaustive and in line with the objectives pursued in the research. It is recommended to broaden the discussion of the limitations of work, and particularly, to analyze the cases in which the adequate sensitivity to diagnose them is not shown.
Author Response
Please see the attachment.
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
To The Authors,
Thank you for your improved submission of the manuscript, which has almost entirely addressed all of my previous concerns.
The remaining issue is the reliance upon dated references, it is not unreasonable to utilize older references if they are the most relevant, however, the average year of your references is approximately early 2000's. I would recommend a review of the literature before finalizing your publication.
