Assessing Fear of Cancer Recurrence among Adolescents and Young Adults: The Portuguese Validation and Psychometric Assessment of the “Fear of Cancer Recurrence 7” Scale
DOI:
https://doi.org/10.20344/amp.22085Keywords:
Adolescent, Fear/psychology, Neoplasm Recurrence, Local/psychology, Psychometrics, Reproducibility of Results, Surveys and Questionnaires, Young AdultAbstract
Introduction: Adolescents and young adults with cancer experience high levels of fear of cancer recurrence (FCR), negatively impacting their lives. However, no measure has been validated worldwide to assess FCR levels among these young people. This study aims to validate the FCR7, a scale that measures FCR, for the Portuguese population of adolescents and young adults.
Methods: Ninety-two participants were recruited online. They were primarily women (83.7%) with a mean age of 26.01 years at recruitment and 19.38 years at cancer diagnosis, with a variety of cancer diagnoses and previous treatments. Most participants were no longer under active treatment (75%), and approximately 75.1 months had passed since their diagnosis. Fear of cancer recurrence, anxiety and depression levels, and quality of life were assessed.
Results: The results showed that FCR7 has good model fit and reliability. Concurrent and divergent validity were also confirmed, with FCR being positively related to anxiety and negatively associated with quality of life. A cut-off score was found, discriminating between clinical and non-clinical levels of FCR. Almost 70% of the participants experienced clinical levels of FCR. We conclude that FCR7 is a valid unidimensional scale to assess FCR levels among Portuguese adolescents and young adults.
Conclusion: More research should be conducted to validate FCR measures to be used among adolescents and young adults across the globe. The existence of a valid and brief measure to assess FCR among this population in Portugal is an asset for national health professionals and researchers.
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References
Lebel S, Ozakinci G, Humphris G, Mutsaers B, Thewes B, Prins J, et al. From normal response to clinical problem: definition and clinical features of fear of cancer recurrence. Support Care Cancer. 2016;24:3265-8.
Almeida SN, Elliott R, Silva ER, Sales CM. Fear of cancer recurrence: a qualitative systematic review and meta-synthesis of patients’ experiences. Clin Psychol Rev. 2019;68:13-24.
Simard S, Thewes B, Humphris G, Dixon M, Hayden C, Mireskandari S, et al. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv. 2013;7:300-22.
Lee-Jones C, Humphris G, Dixon R, Hatcher MB. Fear of cancer recurrence - a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. Psychooncology. 1997;6:95- 105.
Custers JA, Gielissen MF, de Wilt JH, Honkoop A, Smilde TJ, van Spronsen DJ, et al. Towards an evidence-based model of fear of cancer recurrence for breast cancer survivors. J Cancer Surviv. 2017;11:41-7.
Mutsaers B, Butow P, Dinkel A, Humphris G, Maheu C, Ozakinci G, et al. Identifying the key characteristics of clinical fear of cancer recurrence: an international delphi study. Psychooncology. 2020;29:430-6.
Lim E, Humphris G. The relationship between fears of cancer recurrence and patient age: a systematic review and meta-analysis. Cancer Rep. 2020;3:1-14.
Luigjes-Huizer YL, Tauber NM, Humphris G, Kasparian NA, Lam WW, Lebel S, et al. What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review and individual participant data meta-analysis. Psychooncology. 2022;31:879-92.
Adolescent and Young Adult Oncology Progress Review Group. Closing the gap: research and care implications for adolescents and young adults with cancer. 2006. [cited 2024 Jun 28]. Available from: https:// www.cancer.gov/types/aya/research/ayao-august-2006.pdf.
Yang Y, Li W, Wen Y, Wang H, Sun H, Liang W, et al. Fear of cancer recurrence in adolescent and young adult cancer survivors: systematic review of the literature. Psychooncology. 2019;28:675-86.
Sun H, Yang Y, Zhang J, Liu T, Wang H, Garg S, et al. Fear of cancer recurrence, anxiety and depressive symptoms in adolescent and young adult cancer patients. Neuropsychiatr Dis Treat. 2019;15:857-65.
Horwood M, Loades ME, Kosir U, Davis C. Illness perceptions, fear of cancer recurrence, and mental health in teenage and young adult cancer survivors. J Pediatr Hematol Oncol Nurs. 2024;41:44-55.
Vandraas KF, Reinertsen KV, Kiserud CE, Lie HC. Fear of cancer recurrence among young adult cancer survivors—exploring long-term contributing factors in a large, population-based cohort. J Cancer Surviv. 2021;15:497-508.
Schapira L, Zheng Y, Gelber SI, Poorvu P, Ruddy KJ, Tamimi RM, et al. Trajectories of fear of cancer recurrence in young breast cancer survivors. Cancer. 2022;128:335-43.
What should the age range be for AYA oncology? J Adolesc Young Adult Oncol. 2011;1:3-10.
McCarthy MC, McNeil R, Drew S, Dunt D, Kosola S, Orme L, et al. Psychological distress and posttraumatic stress symptoms in adolescents and young adults with cancer and their parents. J Adolesc Young Adult Oncol. 2016;5:322-9.
European Comission. Europe’s beating cancer plan: communication from the commission to the european parliament and the council. 2021. [cited 2024 Dec 15]. Available from: https://health.ec.europa.eu/system/ files/2022-02/eu_cancer-plan_en_0.pdf.
Instituto Português de Oncologia do Porto Francisco Gentil. Registo oncológico nacional de todos os tumores na população residente em Portugal, em 2020. 2023. [cited 2024 Dec 15]. Available from: https:// ron.min-saude.pt/media/2223/ron-2020.pdf.
Instituto Português de Oncologia Francisco Gentil. Registo oncológico nacional 2001. 2008. [cited 2024 Dec 15]. Available from: https://ron. min-saude.pt/media/1598/ron-2001.pdf.
Zebrack BJ. Psychological, social, and behavioral issues for young adults with cancer. Cancer. 2011;117:2289-94.
Richter D, Clever K, Mehnert-Theuerkauf A, Schönfelder A. Fear of recurrence in young adult cancer patients—a network analysis. Cancers. 2022;14:1-12.
Smith AW, Seibel NL, Lewis DR, Albritton KH, Blair DF, Blanke CD, et al. Next steps for adolescent and young adult oncology workshop: An update on progress and recommendations for the future. Cancer. 2016;122:988-99.
Costa DS, Smith A “Ben”, Fardell JE. The sum of all fears: conceptual challenges with measuring fear of cancer recurrence. Support Care Cancer. 2016;24:1-3.
Humphris GM, Watson E, Sharpe M, Ozakinci G. Unidimensional scales for fears of cancer recurrence and their psychometric properties: the FCR4 and FCR7. Health Qual Life Outcomes. 2018;16:1-12.
Lee YH, Hu CC, Humphris G, Huang IC, You KL, Jhang SY, et al. Screening for fear of cancer recurrence: Instrument validation and current status in early stage lung cancer patients. J Formos Med Assoc. 2020;119:1101-8.
Nandakumar D, Veeriah S, Krishnamurthy A, Veluswami S, Ananthi B. Fear of cancer recurrence 7 scale tamil translation and validation among breast cancer survivors in India. Indian J Palliat Care. 2022;28:321-7.
Bergerot CD, Ferreira LN, Molina LN, Pagung LB, Pedersen B da S, de Andrade TG, et al. Fear of cancer recurrence among Brazilian patients with cancer: translation and cultural adaptation of FCR4/7 and FCRI-SF measures. J Psychosom Res. 2023;165:111125.
Pais-Ribeiro J, Silva I, Ferreira T, Martins A, Meneses R, Baltar M. Validation study of a Portuguese version of the hospital anxiety and depression scale. Psychol Health Med. 2007;12:225-37.
Zigmond AS, Snalth RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361-70.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. the european organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365-76.
Pais-Ribeiro J, Pinto C, Santos C. Validation study of the portuguese version of the QLC-C30-V.3. Psicologia, Saúde & Doenças. 2008;9:89- 102.
Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60:34-42.
DiStefano C, Liu J, Jiang N, Shi D. Examination of the weighted root mean square residual: evidence for trustworthiness? Struct Equ Modeling. 2018;25:453-66.
Kline RB. Principles and practice of structural equation modeling. New York: The Guilford Press; 2016.
Schermelleh-Engel K, Moosbrugger H, Müller H. Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures. MPR Online. 2003;8:23-74.
Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018;126:1763-8.
Ratner B. The correlation coefficient: Its values range between 1/1, or do they. J Target Meas Anal Mark. 2009;17:139-42.
Hajian-Tilaki K. Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian J Intern Med. 2013;4:627-35.
Habibzadeh F, Habibzadeh P, Yadollahie M. On determining the most appropriate test cut-off value: the case of tests with continuous results. Biochem Med. 2016;26:297-307.
Unal I. Defining an optimal cut-point value in ROC analysis: an alternative approach. Comput Math Methods Med. 2017;2017:3762651.
Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6:1-55.
Brown TA. Confirmatory factor analysis for applied research. New York: The Guilford Press; 2015.
Nahm FS. Receiver operating characteristic curve: overview and practical use for clinicians. Korean J Anesthesiol. 2022;75:25-36.
Cohen J. Statistical power analysis for the behavioral sciences second edition. New Jersey: Lawrence Erlbaum Associates, Inc.:1988.
Byrne BM. Structural equation modeling with AMOS. New York: Routledge: 2010.
Shi D, Lee T, Maydeu-Olivares A. Understanding the model size effect on SEM fit indices. Educ Psychol Meas. 2019;79:310-34.
Peng L, Huang W, Zhang W, Xu Y, Lu F, Zhong L, et al. Psychometric properties of the short form of the fear of cancer recurrence inventory (FCRI) in Chinese breast cancer survivors. Front Psychiatry. 2019;10:1- 7.
Cho D, Park CL. Moderating effects of perceived growth on the association between fear of cancer recurrence and health-related quality of life among adolescent and young adult cancer survivors. J Psychosoc Oncol. 2017;35:148-65.
Thewes B, Kaal SE, Custers JA, Manten-Horst E, Jansen R, Servaes P, et al. Prevalence and correlates of high fear of cancer recurrence in late adolescents and young adults consulting a specialist adolescent and young adult (AYA) cancer service. Support Care Cancer. 2018;26:1479- 87.
Taylor RM, Whelan JS, Gibson F, Morgan S, Fern LA. Involving young people in BRIGHTLIGHT from study inception to secondary data analysis: insights from 10 years of user involvement. Res Involv Engagem. 2018;4:1-14.
Williams JT, Pearce A, Smith A Ben. A systematic review of fear of cancer recurrence related healthcare use and intervention cost-effectiveness. Psychooncology. 2021;30:1185-95.
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