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

Abstract

Fear 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. The 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. 107 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). The 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.