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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.
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.
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.
Query for this technology: (TITLE:"Measuring fear of recurrence: the FCRI and its cut-off" OR ABSTRACT:"Measuring fear of recurrence: the FCRI and its cut-off") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Measuring fear of recurrence: the FCRI and its cut-off, not a curated reading list.
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Shares How recovery is measured: the questionnaires behind the numbers, Patients lack understanding, navigation and agency, Quality of life, HR-positive / HER2-negative breast cancer and the tags rejuvenation, survivorship, measurement, instruments.
Shares How recovery is measured: the questionnaires behind the numbers, Patients lack understanding, navigation and agency, Quality of life, HR-positive / HER2-negative breast cancer and the tags rejuvenation, survivorship, measurement, instruments.
Shares How recovery is measured: the questionnaires behind the numbers, Patients lack understanding, navigation and agency, Quality of life, HR-positive / HER2-negative breast cancer and the tags rejuvenation, survivorship, measurement, instruments.
Shares How recovery is measured: the questionnaires behind the numbers, Patients lack understanding, navigation and agency, Quality of life, HR-positive / HER2-negative breast cancer and the tags rejuvenation, survivorship, measurement, instruments.