Synbiotics in Oncology: A Scoping Review Protocol on Their Impact and Outcomes in Cancer Care

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The project is worth consideration for publication.

Data collection and data analysis will require a great effort, I wish you good luck.

English language is very formal, maybe a bit too much. I suggest minor revision. 

Comments on the Quality of English Language

English language is very formal, maybe a bit too much. I suggest minor revision.

Author Response

Thank you for appreciating our work. We edited English language as per your comment.

Reviewer 2 Report

Comments and Suggestions for Authors

The authors of this paper claim that they developed a protocol for conducting a scoping review to assess the available evidence on probiotic use in cancer symptom management among adults.

The main criticism is that the authors mainly focus on ”the diverse clinical outcomes potentially enhanced by probiotic intake”. However, in my opinion a scoping review in this field should also (and especially) include evidence for infectious complications associated to the use of live microorganisms in vulnerable people such as cancer patients.

Other critical points are summarized below.

1)    It is not clear whether the authors address cancer symptoms or cancer treatment side effects. The use of consistent terminology is advised.

2)    It is not clear whether the authors focus on probiotics, as stated in the title, or they also consider prebiotics and symbiotics as often mentioned in the text.

3)    The results section is not proper in this paper since it provides a protocol description with no results yet available.  

4)    The definition of “quasi-experimental” (lines 148 and 152) should be provided.

5)    The inclusion of the first author among selection criteria (line 174) seems irrelevant.

Further criticism concerns redundancy, for instance concerning the scope of the study which is repeated in different sections and should be avoided.

For the reasons detailed above, my personal recommendation is that this manuscript needs major revisions before being considered for publication.

Author Response

Please find the point-by-point response to the reviewer’s comments here attached. 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The authors had an interesting idea on the use of probiotics in oncology.

Abstract is too general and has no practical outcome on patient care.” … will tailor future research”.

Introduction is too general. I suggest to the authors to present different cancer types and the correlation with nutritional metabolomics.

Research design: I was expecting a more practical approach

Methods- is a general presentation of the literature search.

Results- lack the patient outcome.

I suggest major revisions

Author Response

We appreciate the opportunity to clarify the intent and value of our study, which focuses on the use of probiotics in oncology. The primary aim of our study is to map the landscape of clinical outcomes in the field of probiotics and cancer, acknowledging the current gap in specific patient outcomes. This lack of clear, direct patient outcomes, as highlighted in your comments, underscores the necessity for our scoping review. Our goal is to establish a comprehensive foundation for future, more targeted research that can address these gaps by identifying and synthesizing existing research. In response to your comment on the abstract and introduction's generality, we aimed to set a broad context for our study, considering the diverse mechanisms through which probiotics might influence cancer therapy and patient care. However, we recognize the importance of specificity and practical implications for patient care and will refine these sections to better reflect the direct relevance and potential applications of our findings. Regarding the research design and methods, our choice of a scoping review was deliberate. Scoping reviews are particularly valuable in emerging research areas like probiotics in oncology, where it is crucial to first map the field and identify the extent, range, and nature of research activity. This approach allows us to highlight the current state of knowledge, identify key concepts, and reveal research gaps, thereby laying the groundwork for practical, future research that can directly impact patient care.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The work has greatly improved. However, I would strongly recommend to avoid the general term of “microbiome modifiers” in the title and in the text, unless you give a detailed and very accurate definition of what you mean for “microbiome modifiers”. Many substances besides probiotics and synbiotics (antibiotics, for instance) can be referred to as “microbiome modifiers”, thus the aim of this study would not be correctly focused. Definitions are very important in this field: so, if you mean probiotics and synbiotics, just use those terms. Please, also consider that the term synbiotic (with n) would be more appropriate than symbiotic (ref.  Swanson, K.S., Gibson, G.R., Hutkins, R. et al. The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of synbiotics. Nat Rev Gastroenterol Hepatol 17, 687–701 (2020).

Author Response

Please find attached our response. 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Comments for author File: Comments.pdf

Author Response

Reviewer 3	AUTHORS’ RESPONSE
I went very carefully through the new version of the article, and the authors answered only partly to my comments. I indicated a more practical approach for the patient outcome. The authors answered, but haven’t changed the contents- you should add a paragraph in which you enumerate the benefits of your protocol.	Thank you for being so accurate to our analysis. This approach will improve the quality of our manuscript certainly.
I asked to change the abstract, and the expression: “will tailor future research” is still there.	We replaced this expression “will tailor future research” with “will shape future research”.
I suggested that Introduction should contain different cancer types. This was not mentioned in the revised version.	Thank you for this comment We amended as per your comment.
I indicated a more practical approach for the patient outcome. The authors answered, but haven’t changed the contents- you should add a paragraph in which you enumerate the benefits of your protocol.	We better specified the population target, interventions and outcomes that we intend to investigate with our study in the “Eligibility Criteria” paragraph. Further, we added a paragraph with benefits of our protocol (“Protocol benefits and application”).

 

Author Response File: Author Response.pdf