Psychology Research and Behavior Management (Dec 2020)
Spotlight on the Fear of Cancer Recurrence Inventory (FCRI)
Abstract
Allan Ben Smith,1,2,* Daniel Costa,2,3,* Jacqueline Galica,2,4,5,* Sophie Lebel,2,6,* Nina Tauber,2,7,* Sanne Jasperine van Helmondt,2,8,9,* Robert Zachariae2,7,* 1Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia; 2FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada; 3School of Psychology, University of Sydney, Sydney, New South Wales, Australia; 4School of Nursing, Queen’s University, Kingston, Ontario, Canada; 5Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Kingston, Ontario, Canada; 6School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; 7Unit for Psychooncology and Health Psychology (EPoS), Department of Oncology, Aarhus University Hospital and Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark; 8Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; 9Scientific Research Department, Helen Dowling Institute, Bilthoven, the Netherlands*These authors contributed equally to this workCorrespondence: Allan Ben SmithFORwards, Psycho-Oncology Research Group, Ingham Institute, Liverpool Hospital, Locked Bag 7103, Liverpool BC NSW, BC NSW, AustraliaTel +61 2 87389244Email [email protected]: Fear of cancer recurrence (FCR) is a pervasive concern for people living with cancer. The rapidly expanding FCR literature has been weakened somewhat by use of miscellaneous FCR measures of varying quality. The Fear of Cancer Recurrence Inventory (FCRI) has been widely used in observational and intervention studies and the FCRI severity subscale, also known as the FCRI-Short Form (FCRI-SF), is often used to identify potential cases of clinically significant FCR. Given the FCRI’s increasing use in research and clinical practice, we aimed to provide an overview, critique, and suggested improvements of the FCRI. Studies citing the original FCRI validation paper were identified and synthesised using narrative and meta-analytic methods. The 42-item FCRI has demonstrated a reasonably robust 7-factor structure across evaluations in multiple languages, although certain subscales (eg, Coping) demonstrate sub-optimal reliability. Confirmation of the cross-cultural equivalence of several FCRI translations is needed. Meta-analysis of FCRI-SF scores revealed a combined weighted mean score of 15.7/36, a little above the lowest proposed cut-off score (≥ 13) for clinical FCR. Depending on the FCRI-SF cut-off used, between 30.0% and 53.9% of the cancer population (ie, patients and survivors) appear to experience sub-clinical or clinical FCR. Higher FCRI scores were associated with younger age and female gender, pain/physical symptoms and psychological morbidity, consistent with the FCR literature generally. Issues regarding the application and interpretation of the FCRI remain. Whether the FCRI is well suited to assessing fear of progression as well as recurrence is unclear, the meaningfulness of the FCRI total score is debatable, and the use of the FCRI-SF to screen for clinical FCR is problematic, as items do not reflect established characteristics of clinical FCR. Refinement of the FCRI is needed for it to remain a key FCR assessment tool in future research and clinical practice.Keywords: cancer, fear of recurrence, survivorship, oncology, questionnaire, self-report measure
