Evaluation of the validity and screening performance of a revised single‐item fear of cancer recurrence screening measure (FCR‐1r)

Abstract

AbstractObjectiveFear of cancer recurrence (FCR) is highly prevalent among cancer survivors, but irregularly identified in practice. Single‐item FCR measures suitable for integration into broader psychosocial screening are needed. This study evaluated the validity of a revised version of the original FCR‐1 (FCR‐1r) and screening performance alongside the Edmonton Symptom Assessment System – Revised (ESAS‐r) anxiety item.MethodsThe FCR‐1r was adapted from the FCR‐1 and modelled on the ESAS‐r. Associations between FCR‐1r and FCR Inventory‐Short Form (FCRI‐SF) scores determined concurrent validity. Relationships of FCR‐1r scores with variables related (e.g., anxiety, intrusive thoughts) and unrelated (e.g., employment/marital status) to FCR determined convergent and divergent validity respectively. A Receiver‐Operating Characteristic analysis examined screening performance and cut‐offs for the FCR‐1r and ESAS‐r anxiety item.Results107 participants were recruited in two studies (Study 1, July‐October 2021, n = 54; Study 2: November 2021‐May 2022, n = 53). The FCR‐1r demonstrated concurrent validity against the FCRI‐SF (r = 0.83, p < 0.0001) and convergent validity versus the Generalised Anxiety Disorder‐7 (r = 0.63, p < 0.0001) and Impact of Event Scale‐Revised Intrusion subscale (r = 0.55, p < 0.0001). It did not correlate with unrelated variables (e.g., employment/marital status), indicating divergent validity. An FCR‐1r cut‐off ≥5/10 had 95% sensitivity and 77% specificity for detecting clinical FCR (area under the curve (AUC) = 0.91, 95% CI 0.85–0.97, p < 0.0001); ESAS‐r anxiety cut‐off ≥4 had 91% sensitivity and 82% specificity (AUC = 0.87, 95% CI 0.77–0.98, p < 0.0001).ConclusionsThe FCR‐1r is a valid and accurate tool for FCR screening. Further evaluation of the screening performance of the FCR‐1r versus the ESAS‐r anxiety item in routine care is needed.