FCR-1r 用于恐惧癌症复发的长期结直肠癌幸存者的有效性和筛查能力。
Validity and screening capacity of the FCR-1r for fear of cancer recurrence in long-term colorectal cancer survivors.
机构信息
Department of Clinical Oncology, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark.
South West Sydney Clinical Campuses, Faculty of Medicine and Health, University of New South Wales (UNSW Sydney), Liverpool, Australia.
出版信息
Support Care Cancer. 2023 Nov 11;31(12):690. doi: 10.1007/s00520-023-08159-7.
PURPOSE
Existing fear of cancer recurrence (FCR) screening measures is being shortened to facilitate clinical use. This study aimed to evaluate the validity and screening capacity of a single-item FCR screening measure (FCR-1r) in long-term colorectal cancer (CRC) survivors with no recurrence and assess whether it performs as well in older as in younger survivors.
METHODS
All Danish CRC survivors above 18, diagnosed and treated with curative intent between 2014 and 2018, were located through a national patient registry. A questionnaire including the FCR-1r, which measures FCR on a 0-10 visual analog scale, alongside the validated Fear of Cancer Recurrence Inventory Short Form (FCRI-SF) as a reference standard was distributed between November 2021 and May 2023. Screening capacity and cut-offs were evaluated with a receiver-operating characteristic analysis (ROC) in older (≥ 65 years) compared to younger (< 65 years) CRC survivors. Hypotheses regarding associations with other psychological variables were tested as indicators of convergent and divergent validity.
RESULTS
Of the CRC survivors, 2,128/4,483 (47.5%) responded; 1,654 (36.9%) questionnaires were eligible for analyses (median age 76 (range 38-98), 47% female). Of the responders, 85.2% were aged ≥ 65. Ninety-two participants (5.6%) reported FCRI-SF scores ≥ 22 indicating clinically significant FCR. A FCR-1r cut-off ≥ 5/10 had 93.5% sensitivity and 80.4% specificity for detecting clinically significant FCR (AUC = 0.93, 95% CI 0.91-0.94) in the overall sample. The discrimination ability was significantly better in older (AUC = 0.93, 95% CI 0.91-0.95) compared to younger (0.87, 95% (0.82-0.92), p = 0.04) CRC survivors. The FCR-1r demonstrated concurrent validity against the FCRI-SF (r = 0.71, p < 0.0001) and convergent validity against the short-versions of the Symptom Checklist-90-R subscales for anxiety (r = 0.38, p < 0.0001), depression (r = 0.27, p < 0.0001), and emotional distress (r = 0.37, p < 0.0001). The FCR-1r correlated weakly with employment status (r = - 0.09, p < 0.0001) and not with marital status (r = 0.01, p = 0.66) indicating divergent validity.
CONCLUSIONS
The FCR-1r is a valid tool for FCR screening in CRC survivors with excellent ability to discriminate between clinical and non-clinical FCR, particularly in older CRC survivors.
目的
为了便于临床应用，目前正在缩短对癌症复发恐惧（FCR）筛查措施的恐惧。本研究旨在评估一种新的单一项目 FCR 筛查措施（FCR-1r）在无复发的长期结直肠癌（CRC）幸存者中的有效性和筛查能力，并评估其在老年幸存者和年轻幸存者中的表现是否一样好。
方法
通过国家患者登记处，确定所有年龄在 18 岁以上，在 2014 年至 2018 年期间被诊断为并接受根治性治疗的丹麦 CRC 幸存者。在 2021 年 11 月至 2023 年 5 月期间，分发了包括 FCR-1r 的问卷，该问卷使用 0-10 视觉模拟量表测量 FCR，同时还使用经过验证的癌症复发恐惧量表短版（FCRI-SF）作为参考标准。在老年（≥65 岁）和年轻（<65 岁）CRC 幸存者中，通过接收者操作特征分析（ROC）评估筛查能力和截断值。对与其他心理变量的相关性的假设进行了测试，作为收敛和发散效度的指标。
结果
在 CRC 幸存者中，有 2128/4483（47.5%）人做出了回应；1654 份问卷（中位数年龄为 76（范围为 38-98），47%为女性）符合分析条件。在应答者中，85.2%的年龄≥65 岁。92 名（5.6%）参与者报告 FCRI-SF 评分≥22，表明存在临床显著的 FCR。FCR-1r 截断值≥5/10 对检测临床显著的 FCR 具有 93.5%的敏感性和 80.4%的特异性（AUC=0.93，95%置信区间为 0.91-0.94），在整个样本中。在老年幸存者（AUC=0.93，95%置信区间为 0.91-0.95）中，FCR-1r 的区分能力明显优于年轻幸存者（0.87，95%置信区间为 0.82-0.92，p=0.04）。FCR-1r 与 FCRI-SF 具有同时效性（r=0.71，p<0.0001），与症状清单-90-R 子量表的焦虑（r=0.38，p<0.0001）、抑郁（r=0.27，p<0.0001）和情绪困扰（r=0.37，p<0.0001）具有收敛效度。FCR-1r 与就业状况呈弱相关（r=-0.09，p<0.0001），与婚姻状况无关（r=0.01，p=0.66），表明存在发散效度。
结论
FCR-1r 是 CRC 幸存者 FCR 筛查的有效工具，具有出色的区分临床和非临床 FCR 的能力，尤其是在老年 CRC 幸存者中。
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