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The authors commend the topic while raising concerns about interpretability and generalizability, including a relatively small sample size, single-center design, and convenience sampling that may introduce selection bias. They recommend larger multicenter studies, and suggest adding caregiver burden assessment using the Zarit Burden Interview alongside PHQ-9 and GAD-7 for stronger associations.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/letter-to-the-editor-letter-to-the-editor-concerning-the-article-titled-depression-and-anxiety-in-family-caregivers-of-cancer-patients-a-cross-sectional-study-in-nepal/435625/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/letter-to-the-editor-letter-to-the-editor-concerning-the-article-titled-depression-and-anxiety-in-family-caregivers-of-cancer-patients-a-cross-sectional-study-in-nepal/435625.png","ImageObject",300,407,{"name":92,"@type":93},"dhado","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-04","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the main purpose of this letter to the editor?","Question",{"text":112,"@type":113},"To comment on a cross-sectional study about depression and anxiety among family caregivers of cancer patients in Nepal, while highlighting methodological points that could improve interpretability and generalizability.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which methodological issues are raised in the letter?",{"text":117,"@type":113},"Concerns include a relatively small sample size, a single-center design, and non-probability convenience sampling that may reduce statistical power and limit generalizability through selection bias.",{"name":119,"@type":110,"acceptedAnswer":120},"What additional assessment does the letter suggest for future studies?",{"text":121,"@type":113},"The letter recommends assessing caregiver burden using the Zarit Burden Interview (ZBI) in addition to validated tools PHQ-9 and GAD-7, referencing prior work showing stronger associations.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},435625,1790863938,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},5909893218464,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Letter to the Editor  \nLetter to the editor concerning the article titled“Depression and anxiety in family caregivers of cancer patients: a cross-sectional study in Nepal”  \nZainab Salam, MBBSa , Minahil Salam, MBBSb , Malik Olatunde Oduoye, BScc ,*  \nDear Editor,  \nWe read with great interest the article by Egesh Aryal et al[1] titled “Depression and anxiety in family caregivers of cancer patients: A cross-sectional study in Nepal” published in Annals of Medicine and Surgery (Vol. 87, August 2025) . The mental health of caregivers is often overlooked in South Asian families, and we commend the authors for addressing this important issue.  \nHowever, we wish to highlight several methodological considerations that could enhance the interpretability and generalizability of such studies. The sample size of 101 participants, though feasible, is relatively small compared with similar studies[2,3], potentially reducing statistical power. Additionally, the single-center design and use of non-probability convenience sampling may limit generalizability and introduce selection bias. A multicenter approach, as demonstrated by Sharma et al[3], using purposive sampling could yield more representative findings.  \nAlthough validated tools such as PHQ-9 and GAD-7 were appropriately used, the study might have benefited from assessing caregiver burden using the Zarit Burden Interview (ZBI) . Previous research[4] integrating ZBI with PHQ-9 and GAD-7 has demonstrated stronger associations between caregiver burden, anxiety, and depression.  \nThis study is a valuable contribution to understanding caregiver mental health in Nepal. Incorporating larger, multicenter samples and multidimensional assessments of caregiver burden in future research could provide more comprehensive insights.  \naDepartment of Medicine, Nawaz Sharif Medical College, Gujrat, Pakistan, bDepartment of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan and cDepartment of Research, The Medical Research Circle (MedReC), Goma, Congo Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.  \n*Corresponding author. Address: Department of Research, The Medical Research Circle (MedReC), P.O. Box 73, Goma, Congo. Tel.: +2349035928801.  \n[E-mail: malikolatunde36@gmail.com](E-mail: malikolatunde36@gmail.com) (M. O. Oduoye).  \nCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This isan open access article distributed under the terms of the Creative Commons AttributionNon Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Annals of Medicine & Surgery (2026) 88:1080–1081  \nReceived 11 November 2025; Accepted 14 November 2025  \nPublished online 25 November 2025  \n[http://dx.doi.org/10.1097/MS9.0000000000004419](http://dx.doi.org/10.1097/MS9.0000000000004419)  \nDeclarations  \nThis manuscript is prepared according to the TITAN 2025 Guidelines for ethical and transparent use of AI in scholarly publishing[5] .  \nEthical approval  \nNot applicable.  \nConsent  \nNot applicable.  \nSources of funding  \nNone.  \nAuthor contributions  \nConceptualization, project administration, software, and supervision: M.O.O. Writing of initial draft: Z.S., M.S., and M.O.O. Writing – review editing and funding acquisition: M.O.O.  \nConflicts of interest disclosure  \nThe author declares no conflict of interest.  \nResearch registration unique identifying number (UIN)  \nNot applicable.  \nGuarantor  \nMalik Olatunde Oduoye.  \nProvenance and peer review  \nNot commissioned, externally peer-reviewed.  \nData availability statement  \nNot applicable.  \nSalam et al. Annals of Medicine & Surgery (2026)  \nReferences  \n[1] Aryal E, Adhikari SP, Lageju N, et al. Depression and anxiety in family caregivers of cancer patients: a cross-sectional study in Nepal. Ann Med Surg ","cbCail7OGFJ8hJGV","https://ap.wps.com/l/cbCail7OGFJ8hJGV","pdf",161308,"English","# Letter to the Editor\n## Methodological considerations\n## Assessment tools and future directions\n## Declarations and publication details","[{\"question\":\"What is the main purpose of this letter to the editor?\",\"answer\":\"To comment on a cross-sectional study about depression and anxiety among family caregivers of cancer patients in Nepal, while highlighting methodological points that could improve interpretability and generalizability.\"},{\"question\":\"Which methodological issues are raised in the letter?\",\"answer\":\"Concerns include a relatively small sample size, a single-center design, and non-probability convenience sampling that may reduce statistical power and limit generalizability through selection bias.\"},{\"question\":\"What additional assessment does the letter suggest for future studies?\",\"answer\":\"The letter recommends assessing caregiver burden using the Zarit Burden Interview (ZBI) in addition to validated tools PHQ-9 and GAD-7, referencing prior work showing stronger associations.\"}]","Letter to the editor - Letter to the editor concerning the article titled Depression and anxiety in family caregivers of cancer patients - a cross-sectional study in Nepal | PDF",1790674431]