Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Psychooncology. 2023 Feb;32(2):266-274. doi: 10.1002/pon.6066. Epub 2022 Nov 24.
Fear of cancer recurrence (FCR) is common and burdensome to patients, but often remains undetected. Oncology professionals report need for tools to improve FCR detection in routine care. Oncology care guidelines recommend the Distress Thermometer (DT) for distress screening, but it has not been validated for FCR. This study evaluated the capacity of the DT and accompanying problem list to detect FCR.
Amalgamated data of two studies with 149 breast cancer and 74 colorectal cancer survivors were used. We evaluated the Dutch DT including the DT score, problem list fears item and emotional domain score using Receiver Operating Characteristic analyses. The Dutch Cancer Worry Scale-6 (CWS-6) was used as reference measure, with validated cut-off scores ≥10 and ≥12 for high FCR. Sensitivity, specificity, negative and positive predictive values were calculated.
The DT score showed poor performance in discriminating between low and high FCR. The recommended cut-off ≥4 had low sensitivity (65% for CWS-6≥10; 72% for CWS-6 ≥12) and specificity (67% and 58%). No other cut-off had an acceptable combination of sensitivity and specificity. The fears item had low sensitivity (29% and 44.9%) and high specificity (95% and 94%). The emotional domain score had fair performance in discriminating between low and high FCR but there was no cut-off with acceptable sensitivity and specificity.
The DT as currently recommended in oncology care guidelines is not suitable to effectively detect FCR in routine care. To improve patients access to psychosocial care, it should be investigated how FCR-specific measures can be integrated in oncology practice.
癌症复发恐惧（FCR）在患者中很常见且负担沉重，但往往未被发现。肿瘤学专业人员报告需要工具来改善常规护理中的 FCR 检测。肿瘤学护理指南建议使用痛苦温度计（DT）进行痛苦筛查，但尚未对 FCR 进行验证。本研究评估了 DT 及其伴随问题清单检测 FCR 的能力。
使用两项研究的合并数据，其中包括 149 名乳腺癌和 74 名结直肠癌幸存者。我们使用接收器操作特征分析评估了荷兰 DT，包括 DT 评分、问题清单恐惧项目和情绪域评分。荷兰癌症担忧量表-6（CWS-6）被用作参考测量，验证的临界值为≥10 和≥12 用于高 FCR。计算了灵敏度、特异性、阴性和阳性预测值。
DT 评分在区分低和高 FCR 方面表现不佳。推荐的临界值≥4 具有低灵敏度（CWS-6≥10 为 65%；CWS-6≥12 为 72%）和特异性（67%和 58%）。没有其他临界值具有可接受的灵敏度和特异性组合。恐惧项目具有低灵敏度（29%和 44.9%）和高特异性（95%和 94%）。情绪域评分在区分低和高 FCR 方面表现良好，但没有临界值具有可接受的灵敏度和特异性。
目前在肿瘤学护理指南中推荐的 DT 不适用于在常规护理中有效检测 FCR。为了改善患者获得心理社会护理的机会，应研究如何将 FCR 特异性措施整合到肿瘤学实践中。
