Unidimensional scales for fears of cancer recurrence and their psychometric properties: the FCR4 and FCR7

G M Humphris, E Watson, M Sharpe, G Ozakinci, G M Humphris, E Watson, M Sharpe, G Ozakinci

Abstract

Background: The assessment of fear of recurrence (FCR) is crucial for understanding an important psychological state in patients diagnosed and treated for cancer. The study aim was to determine psychometric details of a seven question self-report scale (FCR7) and a short form (FCR4) based upon items already used in various extensive measures of FCR.

Methods: Two consecutive samples of patients (breast and colorectal) were recruited from a single specialist cancer centre. The survey instrument contained the FCR7 items, Hospital Anxiety and Depression Scale (HADS), and demographic details. Clinical information was obtained from patient hospital records. Statistical analyses were performed using classical test and item response theory approaches, to demonstrate unidimensional factor structure and testing key parameters. Construct validity was inspected through nomological and theoretical prediction.

Results: Internal consistency was demonstrated by alpha coefficients (FCR4: 0.93 and FCR7: 0.92). Both scales (FCR7 & FCR4) were associated with the HADs subscales as predicted. Patients who experienced chemotherapy, minor aches/pains, thought avoidance of cancer and high cancer risk belief were more fearful. Detailed inspection of item responses profile provided some support for measurement properties of scales.

Conclusion: The internal consistency, and pattern of key associations and discriminability indices provided positive psychometric evidence for these scales. The brief measures of FCR may be considered for audit, screening or routine use in clinical service and research investigations.

Conflict of interest statement

Authors’ information

GH holds Honorary Consultant Clinical Psychologist contract at the Edinburgh Cancer Centre, Western General Hospital, Edinburgh. MS is supported by the Oxford NIHR CLAHRC.

Ethics approval and consent to participate

All patients were provided with a detailed Patient Information Sheet and given a minimum of 24 h from invitation to signing of a detailed consent form. The study was approved by NRES (07/S1103/27) and NHS Lothian R&D.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Exploratory Factor analysis using Parallel Analysis (a) FCR4 (b) FCR7
Fig. 2
Fig. 2
Fear of recurrence scale (7 items) and HADS Anxiety sub-scale scatterplot with polynomial smoothing and OLS linear regression line fits
Fig. 3
Fig. 3
IRT Test Information Curves for total scale scores (a) FCR4 (b) FCR7 with ±1.96 Theta values marked with solid line to show the 95% proportion of sample and corresponding upper and lower bound scale

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