# Measuring fear of recurrence: the FCRI and its cut-off

Source: https://onco.cc/technologies/rejuv-measure-fear-of-recurrence-inventory/  
OnCo record `rejuv-measure-fear-of-recurrence-inventory` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The most commonly reported unmet need after cancer treatment has a questionnaire of its own. The full version has 42 questions across seven components; the nine-question short form is the one used to screen, and a score of 22 or more marks a level of fear that merits help.

## Summary

The Fear of Cancer Recurrence Inventory was developed because, as its authors put it, "despite the fact that the fear of cancer recurrence is to varying degrees almost universal in cancer survivors, there is a lack of validated multidimensional instruments to evaluate this issue specifically". A pool of 1,704 French-Canadian patients treated for breast, prostate, lung or colorectal cancer within the previous ten years was drawn from a provincial medical databank, and 300 were asked to complete the instrument twice.

The structure. Factor analysis of the final 42-item scale "revealed a seven-component solution (64% of the variance) including the following factors: triggers, severity, psychological distress, coping strategies, functioning impairments, insight, and reassurance". Internal consistency was 0.95 and temporal stability 0.89. That seven-part structure is why the instrument is useful clinically and not only as a score: it separates a person who is frightened and functioning from a person whose fear is driving avoidance, repeated reassurance-seeking or impairment.

The short form and the cut-off. The nine-item severity subscale, used alone as the FCRI-SF, is the screening instrument. Its threshold was re-examined in two samples: 167 Australian survivors from the ConquerFear randomised trial, of whom clinicians rated 43 per cent as having clinical fear of recurrence, and 40 Canadian survivors classified by a semi-structured clinical interview, of whom 25 per cent met criteria. In both, a cut-off of 22 or more on the FCRI-SF identified survivors with clinical levels of fear with adequate sensitivity and specificity, which the authors note is a higher threshold than had previously been used. A service screening at the older, lower cut-off will refer more people than it needs to.

What it misses. It measures fear of recurrence specifically, not general anxiety; the two are correlated but separable, and a generic distress thermometer will miss people whose fear is focused entirely on the cancer. It does not distinguish fear that is proportionate to a genuinely high recurrence risk from fear that is not, and neither does the literature: the relationship between measured risk and reported fear is weak, which is clinically important and uncomfortable for anyone who believes that reassurance about statistics is the answer. Validation outside breast, prostate, lung and colorectal cancer, and in people whose first language is not that of the questionnaire, is thinner than the instrument's popularity suggests.

What to do about a high score belongs to the mind facet of this front, which holds the record on fear of recurrence and the therapies tested against it.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-10-02
- Tags: rejuvenation; survivorship; measurement; instruments; mind
- Principle: A multidimensional self-report measure separates the intensity of fear from its triggers, its behavioural consequences and the person's own insight into it, so that a screening threshold on the severity subscale can be set against a clinical interview rather than against an arbitrary percentile.
- Since: 2009
- Strengths: Measures the most reported unmet need after treatment, which generic distress tools miss; Seven components separate frightened-but-coping from fear that is causing impairment; A screening cut-off validated against clinician rating and a structured interview in two countries; Very high internal consistency and test-retest stability
- Limitations: Fear of recurrence tracks measured recurrence risk only weakly, so a score does not say whether the fear is proportionate; Validation concentrated in four common cancers and in French, English and their translations; The older, lower cut-off is still in use and over-refers; Screening is only worth doing where there is somewhere to refer to

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Cancer_survivor
- Simard and Savard, Fear of Cancer Recurrence Inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence (Support Care Cancer 2009): https://doi.org/10.1007/s00520-008-0444-y
- Fardell et al., Exploring the screening capacity of the Fear of Cancer Recurrence Inventory-Short Form for clinical levels of fear of cancer recurrence (Psycho-Oncology 2018): https://doi.org/10.1002/pon.4516

## Connected records

- technologies: [Anxiety around scans, and what the evidence says about how often to scan](https://onco.cc/technologies/rejuv-mind-scan-anxiety/), [Fear that the cancer will come back: how common it is, and when it stops being ordinary worry](https://onco.cc/technologies/rejuv-mind-fear-of-recurrence/), [Getting psychological help after cancer: the stepped-care model, and what is actually commissioned](https://onco.cc/technologies/rejuv-mind-access-to-psychological-care/), [How recovery is measured: the questionnaires behind the numbers](https://onco.cc/technologies/rejuv-measure-patient-reported-outcomes/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Screening for distress: what the thermometer can and cannot do](https://onco.cc/technologies/rejuv-mind-distress-screening/), [Treating fear of recurrence: the randomised trials, their effect sizes, and where the treatment is available](https://onco.cc/technologies/rejuv-mind-fear-of-recurrence-treatment/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- terms: [Quality of life](https://onco.cc/terms/quality-of-life/)
- bottlenecks: [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)

---
JSON: https://onco.cc/api/v1/entities/rejuv-measure-fear-of-recurrence-inventory.json