Changes in Stress Reduction Following a 28-Day Prostate Cancer Patient Empowerment Program (PC-PEP) among Prostate Cancer Survivors
, Gabriela Ilie 2,3,4,*, Cody MacDonald 2,3, Hayley Riel 5 and Rob David Harold Rutledge 4
Round 1
Reviewer 1 Report
Well conceived study design and an excellent review of mind-body techniques and their potential impact on EEG tracings and HRV.
Even though this was a negative study, I really liked the real world mix of therapies which could or would be applied in this kind of intervention.
My only concern was patient burden with all the testing and activities combined which might be even heavier in a 6 month study decreasing participation, compliance, and drop out rates.
Author Response
August 11, 2023
RESPONSE TO REVIEWER’S QUESTIONS/COMMENTS/SUGGESTIONS
Re: Changes in Stress Reduction Following a 28-Days Prostate Cancer – Patient Empowerment Program (PC-PEP) among Prostate Cancer Survivors
Reviewer 1
Well-conceived study design and an excellent review of mind-body techniques and their potential impact on EEG tracings and HRV.
Even though this was a negative study, I really liked the real-world mix of therapies which could or would be applied in this kind of intervention.
My only concern was patient burden with all the testing and activities combined which might be even heavier in a 6-month study decreasing participation, compliance, and dropout rates.
Response: We thank the reviewer for this comment. We now state this as a potential limitation in the discussion and reference an RCT testing a 6-month version of PC-PEP program of 128 patients with localized disease (see reference 30: Ilie et al., 2023).
Reviewer 2 Report
The authors presented a 28-day multifaceted intervention entitled PCa Patient Empowerment Program (PC-PEP) was created to specifically target the most commonly unmet needs of PCa survivors. The manuscript needs a revision
- The introduction would benefit from a clearer statement of the study's aims and objectives, more information on specific indications and their prevalence, and the inclusion of more recent literature to contextualize the current state of knowledge and the knowledge gap the study seeks to fill. Please shortest the intro by eliminating all elements that could be included in the discussion.
- demographic characteristics should be reported in a supplementary table
- Check typos
Author Response
August 11, 2023
RESPONSE TO REVIEWER’S QUESTIONS/COMMENTS/SUGGESTIONS
Re: Changes in Stress Reduction Following a 28-Days Prostate Cancer – Patient Empowerment Program (PC-PEP) among Prostate Cancer Survivors
Reviewer 2
The authors presented a 28-day multifaceted intervention entitled PCa Patient Empowerment Program (PC-PEP) was created to specifically target the most commonly unmet needs of PCa survivors. The manuscript needs a revision
- The introduction would benefit from a clearer statement of the study's aims and objectives, more information on specific indications and their prevalence, and the inclusion of more recent literature to contextualize the current state of knowledge and the knowledge gap the study seeks to fill. Please shortest the intro by eliminating all elements that could be included in the discussion.
Response: We thank the reviewer for this comment and have made improvements accordingly. We now include a clearer statement of the study’s aim in the introduction on page 3 of the manuscript. The primary aim of the study was to assess the feasibility and safety of 28-day intervention. The primary outcome of the study was mental health. The current investigation is a secondary outcomes analysis concerning stress reduction. Other secondary outcomes including weekly compliance, program evaluation and physical fitness were evaluated previously (see reference 29: Ilie et al., 2020) while urologic function and quality of life are the focus of another manuscript in preparation. Moreover, we now add more specific information on stress, depression/anxiety and their prevalence among PCa on page 2 of the introduction. Furthermore, we shortened the introduction and offered more up to date references in order to provide a more current portrayal of the scholarly landscape.
- demographic characteristics should be reported in a supplementary table
Response: We thank the reviewer for this comment. We have now attached a supplementary document with the demographic characteristics table.
- Check typos
Response: We thank the reviewer for this comment. We have proofread and eliminated typos from the manuscript.
Reviewer 3 Report
This study was reported the changes in stress reduction after post-intervention using PC-PEP. Overall, this paper is well written. However, PC-PEP is an unfamiliar technique to the general urologist, making it somewhat difficult to understand the purpose and results of this paper. The reviewer would like to suggest some critiques to make this paper as follows.
1. On line 21, is “30 PCa survivors” correct? Thirty patients with PCa?
2. On line 49, what is post-prostatectomy?
3. Please change from [12,13,14] and [21,22,23] to [12-14] and [21-23].
4. As a fundamental problem, the OS for prostate cancer is generally considered to be long term. As a fundamental problem, the OS for prostate cancer is generally considered to be long term. Is it reasonable to evaluate at 28 days and 6 months post-treatment?
5. The authors should describe the primary and secondary endpoint in the Introduction section.
Author Response
August 11, 2023
RESPONSE TO REVIEWER’S QUESTIONS/COMMENTS/SUGGESTIONS
Re: Changes in Stress Reduction Following a 28-Days Prostate Cancer – Patient Empowerment Program (PC-PEP) among Prostate Cancer Survivors
Reviewer 3
This study was reported the changes in stress reduction after post-intervention using PC-PEP. Overall, this paper is well written. However, PC-PEP is an unfamiliar technique to the general urologist, making it somewhat difficult to understand the purpose and results of this paper. The reviewer would like to suggest some critiques to make this paper as follows.
- On line 21, is “30 PCa survivors” correct? Thirty patients with PCa?
Response: We thank the reviewer for this edit. We now updated this to “thirty patients with PCa” on page 1 and 3 of the manuscript.
- On line 49, what is post-prostatectomy?
Response: We thank the reviewer for this comment. We now clarified this as “having had their prostate surgically removed” on page 2 of the manuscript.
- Please change from [12,13,14] and [21,22,23] to [12-14] and [21-23].
Response: We thank the reviewer for this comment. We have now updated this format throughout the manuscript on pages 2, 5, 11, 12, and 13.
- As a fundamental problem, the OS for prostate cancer is generally considered to be long term. Is it reasonable to evaluate at 28 days and 6 months post-treatment?
Response: We thank the reviewer for this comment. Indeed, overall survival is considered to be long-term among prostate cancer patients hence the evaluation would make more sense to be longer (28 days and 6 months). The purpose of the 28 days assessment was purely for feasibility and safety to aid us in the development of the 6 and 12 months assessment of a 6 months version of the program. We now state on page 13 of the manuscript that a follow-up randomized clinical trial phase 3 was conducted using a longer version of the program (6 months) and assessments were obtained at baseline, 6, and 12 months. Here, we were simply concerned with feasibility and safety.
- The authors should describe the primary and secondary endpoint in the Introduction section.
Response: We thank the reviewer for this comment. We have now state the primary (mental health) and secondary outcomes (stress reduction, weekly compliance, quality of life, urologic function, and physical fitness) of the study in the introduction on page 3 of the manuscript.
Round 2
Reviewer 2 Report
the revised version has improved the overall quality of the manuscript. some amendments are still required:
- Discuss the clinical implications of the results and future research directions.
- Authors should read these novel papers on the topic to update their references and find a new point of discussion: PMID: 36294423; PMID: 37446024.
Author Response
August 16, 2023
RESPONSE TO REVIEWER’S QUESTIONS/COMMENTS/SUGGESTIONS
Re: Changes in Stress Reduction Following a 28-Days Prostate Cancer – Patient Empowerment Program (PC-PEP) among Prostate Cancer Survivors
The revised version has improved the overall quality of the manuscript. some amendments are still required:
- Discuss the clinical implications of the results and future research directions.
Response: We thank the reviewer for this comment. We now discuss the clinical implications of the results and future research directions in the discussion on page 14.
- Authors should read these novel papers on the topic to update their references and find a new point of discussion: PMID: 36294423; PMID: 37446024.
Response: We thank the reviewer for this suggestion. We read the papers suggested by the reviewer and provided clinical implication of the results in the discussion.
Reviewer 3 Report
none.
Author Response
August 15, 2023
RESPONSE TO REVIEWER’S QUESTIONS/COMMENTS/SUGGESTIONS
Re: Changes in Stress Reduction Following a 28-Days Prostate Cancer – Patient Empowerment Program (PC-PEP) among Prostate Cancer Survivors
None.
Response: We thank the reviewer for their previous comments and inspired revisions.
