Psychosocial Interventions for the Treatment of Cancer-Related Fatigue: An Umbrella Review

Round 1

Reviewer 1 Report

The review presents a useful collection of the best data regarding psychosocial interventions for cancer that would be useful as a foundation on which to base further study and avoid repetition. The language is excessively long and the overall length of the article should be reduced in order to convey the information more easily to a reader. The English usage is marginal and proofreading for both readability and brevity by a native English speaker is advised.

Many of the tables the abbreviations and symbols used are difficult to interpret at a glance and more attention to taking advantage of visual data presentation methods is suggested.

Lastly, summary of the evidence and basic recommendations for practice and/or further research would be helpful at the end of the article.

Author Response

We hope that our language limitations do not detract from the work we have done.

Following your indications, the whole document has been revised by the editorial services of the journal, in order to improve the expression and grammar of the document.

We have synthesised the tables and summarised some aspects to improve the reader's comprehension. Some data have been moved to the appendix to improve clarity in the main text.

We have eliminated abbreviations in the tables, and used visual methods where possible, to present data more clearly.

Finally, we have added at the end of the article basic recommendations for practice and future research, as well as a summary of key ideas.

Thank you for your recommendations

Reviewer 2 Report

Review

 

Thank you for the opportunity to review this paper that provides insight into the state of science concerning cancer related fatigue and psychosocial interventions. The following suggestions are provided in a hope to improve the readability and impact of this paper.

 

-       There are several typos and missing periods throughout the paper and the text warrants review for English grammar.

-       The introduction would be strengthened with a summary of previous reviews on this topic and their own limitations. This would provide further justification for such an umbrella review.  

-       The discussion includes a lot of repetition of the results and key findings, rather than a focus on the implications of these results and how they compare to previous reviews on this topic.

-       Attention to the earlier point would provide space for greater exploration of how the field can move forward in addressing cancer related fatigue. The authors emphasize the importance of longitudinal research; however, it is also clear that there is insufficient support for any interventions even in the short term.

-       For example, how should the heterogenous nature of assessment measures be addressed? Given fatigue often presents in addition to other cancer-related side-effects or symptoms, do we need a specific targeted intervention for fatigue or would the field (and patients) profit more from broader evidence based interventions?

 

Author Response

We hope that our language limitations do not detract from the work we have done.

Following your indications, the whole document has been revised by the editorial services of the journal, in order to improve the expression and grammar of the document.

We have revised the discussion to avoid repetition and have pointed out basic recommendations for practice and future research, as well as a summary of ideas to be highlighted.

We have pointed out the strengths of some interventions, even if the level of recommendation is not high, due to the lack of homogeneity in the comparison of data.

We have shown how the studies seem to point to improvements in fatigue, when the intervention is specific to fatigue, as well as other promising variables.

We have synthesised the tables and summarised some aspects to improve the reader's comprehension. Some data have been moved to the appendix to improve clarity in the main text.

Finally, in the review authors' own conclusions, the limitations they have encountered are noted. For this reason, we have not included in the introduction a summary of the previous reviews on this topic and their own limitations.

We hope that we have improved towards a clearer and more concrete text.

Thank you for your recommendations.

Round 2

Reviewer 1 Report

The revision significantly improves upon the English readability and presentation of data in tables. Given the publication in a journal primarily targeting oncology practitioners, the lengthy discussion/conclusions sections would still benefit from further distillation and tighter presentation of information lest the reader become lost in too many words. More concise language and avoidance of review of information already stated in earlier sections would improve the clarity and strength of the central message that only CBT  shows benefit for CRF and even then the effect is modest, thus more study is needed.