Smith Allan Ben, Costa Daniel, Galica Jacqueline, Lebel Sophie, Tauber Nina, van Helmondt Sanne Jasperine, Zachariae Robert
Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia.
FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada.
Psychol Res Behav Manag. 2020 Dec 21;13:1257-1268. doi: 10.2147/PRBM.S231577. eCollection 2020.
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.
对癌症复发的恐惧(FCR)是癌症患者普遍存在的担忧。由于使用了质量参差不齐的各种FCR测量方法,迅速扩充的FCR文献在一定程度上受到了削弱。癌症复发恐惧量表(FCRI)已在观察性研究和干预性研究中广泛使用,FCRI严重程度分量表,也称为FCRI简表(FCRI-SF),常被用于识别具有临床意义的FCR潜在病例。鉴于FCRI在研究和临床实践中的使用日益增加,我们旨在对FCRI进行概述、批评并提出改进建议。通过叙述性和荟萃分析方法,识别并综合了引用原始FCRI验证论文的研究。42项的FCRI在多种语言的评估中都显示出了相当稳健的7因素结构,尽管某些分量表(如应对)的信度并不理想。需要确认几种FCRI翻译版本的跨文化等效性。对FCRI-SF分数的荟萃分析显示,综合加权平均分是15.7/36,略高于临床FCR建议的最低临界分数(≥13)。根据所使用的FCRI-SF临界值,30.0%至53.9%的癌症人群(即患者和幸存者)似乎经历了亚临床或临床FCR。较高的FCRI分数与较年轻的年龄、女性性别、疼痛/身体症状以及心理疾病相关,这与一般的FCR文献一致。关于FCRI的应用和解释仍存在问题。FCRI是否同样适用于评估对病情进展以及复发的恐惧尚不清楚,FCRI总分的意义存在争议,并且使用FCRI-SF筛查临床FCR存在问题,因为其条目并未反映临床FCR已确立的特征。为了使其在未来的研究和临床实践中仍然是关键的FCR评估工具,需要对FCRI进行完善。