Skip to main content

Advertisement

SpringerLink
Log in

Assessing the fear of recurrence using the Cancer Worry Scale in a sample of Italian breast cancer survivors

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

The fear of cancer recurrence (FCR) is one of the most reported problems by cancer survivors. A valid instrument to detect this issue could be useful to identify cancer survivors who are more vulnerable to developing FCR and related adverse outcomes (e.g., anxiety). The present study aimed to evaluate FCR in a sample of Italian breast cancer survivors using an Italian version of the 8-item Cancer Worry Scale (CWS) in order to establish a cut-off for the use in clinical settings.

Methods

The participants were 119 breast cancer survivors (mean age 47.7 years) at least 1 year after their primary treatment. An exploratory factor analysis (EFA) of CWS, internal reliability of CWS, concurrent and divergent validity using a bivariate correlation between the key measures of the study (i.e., FCR, anxiety, depression, fatigue, and self-efficacy), and ROC analysis of CWS were performed.

Results

Fit indices for the EFA were considered acceptable and showed a two-factor structure-labeled cancer worries and worries impact. The reliability of the two factors showed a Cronbach’s alpha coefficient greater than 0.90. The CWS was positively related to anxiety, depression, fatigue, and negatively related to perceived self-efficacy. The best cut-off score was 24 versus 25, with a sensitivity of 74% and a specificity of 85%.

Conclusions

The CWS is a valid questionnaire to assess FCR among breast cancer survivors. The present study provides an overview of the relationship between CWS and the adverse outcomes related to FCR and coping strategies adopted to face it.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The raw data supporting the conclusions of this article are available on https://osf.io/vng35/.

Code availability

N/A.

References

  1. Winters S, Martin C, Murphy D, Shokar NK (2017) Breast cancer epidemiology, prevention, and screening. Prog Mol Biol Transl Sci 151:1–32. https://doi.org/10.1016/bs.pmbts.2017.07.002

    Article  CAS  PubMed  Google Scholar 

  2. Italian Association of Cancer Registers (2019) I numeri del cancro in Italia. https://www.registritumori.it/cms/pubblicazioni/i-numeri-del-cancro-italia-2019

  3. Lebel S et al (2017) Current state and future prospects of research on fear of cancer recurrence. Psychooncology. https://doi.org/10.1002/pon.4103

    Article  PubMed  Google Scholar 

  4. Tauber NM et al (2019) Effect of psychological intervention on fear of cancer recurrence: a systematic review and meta-analysis. J Clin Oncol. https://doi.org/10.1200/JCO.19.00572

    Article  PubMed  PubMed Central  Google Scholar 

  5. Thewes B, Butow P, Zachariae R, Christensen S, Simard S, Gotay C (2012) Fear of cancer recurrence: a systematic literature review of self-report measures. Psycho-Oncology. https://doi.org/10.1002/pon.2070

    Article  PubMed  Google Scholar 

  6. Champion VL et al (2004) A breast cancer fear scale: psychometric development. J Health Psychol. https://doi.org/10.1177/1359105304045383

    Article  PubMed  Google Scholar 

  7. Berrenberg JL (1991) The cancer attitude inventory: development and validation. J Psychosoc Oncol. https://doi.org/10.1300/J077v09n02_03

    Article  Google Scholar 

  8. Gramling R, Anthony D, Frierson G, Bowen D (2007) The cancer worry chart: a single-item screening measure of worry about developing breast cancer. Psychooncology. https://doi.org/10.1002/pon.1128

    Article  PubMed  Google Scholar 

  9. Custers JAE, Van Den Berg SW, Van Laarhoven HWM, Bleiker EMA, Gielissen MFM, Prins JB (2014) The cancer worry scale: detecting fear of recurrence in breast cancer survivors. Cancer Nurs. https://doi.org/10.1097/NCC.0b013e3182813a17

    Article  PubMed  Google Scholar 

  10. Caruso A, Vigna C, Gremigni P (2018) The Cancer Worry Scale revised for breast cancer genetic counseling. Cancer Nurs. https://doi.org/10.1097/NCC.0000000000000511

    Article  PubMed  Google Scholar 

  11. Cabrera E, Zabalegui A, Blanco I (2011) Spanish version of the Cancer Worry Scale (CWS). Cross cultural adaptation and validity and reliability analysis. Med Clin (Barc). https://doi.org/10.1016/j.medcli.2010.04.015

    Article  Google Scholar 

  12. Lerman C, Kash K, Stefanek M (1994) Younger women at increased risk for breast cancer: perceived risk, psychological well-being, and surveillance behavior. J Natl Cancer Inst Monogr 1(16):171–176

    Google Scholar 

  13. Watson M et al (1998) Family history of breast cancer: What do women understand and recall about their genetic risk? J Med Genet. https://doi.org/10.1136/jmg.35.9.731

    Article  PubMed  PubMed Central  Google Scholar 

  14. Douma KFL et al (2010) Psychological distress and use of psychosocial support in familial adenomatous polyposis. Psychooncology. https://doi.org/10.1002/pon.1570

    Article  PubMed  Google Scholar 

  15. Van De Wal M, Thewes B, Gielissen M, Speckens A, Prins J (2017) Efficacy of blended cognitive behavior therapy for high fear of recurrence in breast, prostate, and colorectal cancer survivors: the SWORD study, a randomized controlled trial. J Clin Oncol. https://doi.org/10.1200/JCO.2016.70.5301

    Article  PubMed  Google Scholar 

  16. Custers JAE, Gielissen MFM, Janssen SHV, de Wilt JHW, Prins JB (2016) Fear of cancer recurrence in colorectal cancer survivors. Support Care Cancer. https://doi.org/10.1007/s00520-015-2808-4

    Article  PubMed  PubMed Central  Google Scholar 

  17. Custers JAE, Tielen R, Prins JB, De Wilt JHW, Gielissen MFM, Van Der Graaf WTA (2015) Fear of progression in patients with gastrointestinal stromal tumors (GIST): is extended lifetime related to the Sword of Damocles? Acta Oncol (Madr). https://doi.org/10.3109/0284186X.2014.1003960

    Article  Google Scholar 

  18. Thewes B et al (2018) 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. https://doi.org/10.1007/s00520-017-3975-2

    Article  PubMed  Google Scholar 

  19. Schneider K (2002) Counseling about cancer: Strategies for genetic counselors, 2nd edn. Wiley-Liss, New York

    Google Scholar 

  20. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

    Article  PubMed  Google Scholar 

  21. Serpentini S et al (2019) Self-efficacy for coping: utility of the Cancer behavior inventory (Italian) for use in palliative care. BMC Palliat Care 18(1):1–9. https://doi.org/10.1186/s12904-019-0420-y

    Article  Google Scholar 

  22. T. Rstudio (2020) "RStudio: Integrated Development for R.," Rstudio Team, PBC, Boston, MA URL http://www.rstudio.com/https://doi.org/10.1145/3132847.3132886

  23. Revelle W (2019) Psych: procedures for psychological, psychometric, and personality research. R package version 1.9.12. Retrieved from https://CRAN.R-project.org/package=psych

  24. Bernaards CA, Jennrich RI (2005) Gradient projection algorithms and software for arbitrary rotation criteria in factor analysis. Educ Psychol Meas. https://doi.org/10.1177/0013164404272507

    Article  Google Scholar 

  25. S. Korkmaz, D. Goksuluk, and G. Zararsiz (2014) MVN: an R package for assessing multivariate normality. R J. https://doi.org/10.32614/rj-2014-031

  26. Horn JL (1965) A rationale and test for the number of factors in factor analysis. Psychometrika. https://doi.org/10.1007/BF02289447

    Article  PubMed  Google Scholar 

  27. Williams B, Onsman A, Brown T (2010) Exploratory factor analysis: a five-step guide for novices. J Emerg Prim Heal Care. https://doi.org/10.33151/ajp.8.3.93

    Article  Google Scholar 

  28. Hu LT, Bentler PM (1999) Cut-off criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. https://doi.org/10.1080/10705519909540118

    Article  Google Scholar 

  29. Tavakol M, Dennick R (2011) Post-examination analysis of objective tests. Med Teach. https://doi.org/10.3109/0142159X.2011.564682

    Article  PubMed  Google Scholar 

  30. Custers JAE, Kwakkenbos L, van de Wal M, Prins JB, Thewes B (2018) Re-validation and screening capacity of the 6-item version of the Cancer Worry Scale. Psychooncology. https://doi.org/10.1002/pon.4782

    Article  PubMed  Google Scholar 

  31. Chirico A et al (2017) A meta-analytic review of the relationship of cancer coping selfefficacy with distress and quality of life. Oncotarget 8(22):36800–36811. https://doi.org/10.18632/oncotarget.15758

    Article  PubMed  PubMed Central  Google Scholar 

  32. Servaes P, Verhagen S, Schreuder HWB, Veth RPH, Bleijenberg G (2003) Fatigue after treatment for malignant and benign bone and soft tissue tumors. J Pain Symptom Manage. https://doi.org/10.1016/j.jpainsymman.2003.03.001

    Article  PubMed  Google Scholar 

  33. Gielissen MFM, Schattenberg AVM, Verhagen CAHHVM, Rinkes MJ, Bremmers MEJ, Bleijenberg G (2007) Experience of severe fatigue in long-term survivors of stem cell transplantation. Bone Marrow Transplant. https://doi.org/10.1038/sj.bmt.1705624

    Article  PubMed  Google Scholar 

  34. American Cancer Society (2006) Institute of Medicine. From cancer patient to cancer survivor: lost in transition. Natl. Acadmies Press, Washington DC

    Google Scholar 

  35. Brandenbarg D, Berendsen AJ, de Bock GH (2017) Patients’ expectations and preferences regarding cancer follow-up care. Maturitas. https://doi.org/10.1016/j.maturitas.2017.07.001

    Article  PubMed  Google Scholar 

  36. Laporte C et al (2017) French women’s representations and experiences of the post-treatment management of breast cancer and their perception of the general practitioner’s role in follow-up care: a qualitative study. Heal Expect. https://doi.org/10.1111/hex.12518

    Article  Google Scholar 

  37. Hodges LJ, Humphris GM (2009) Fear of recurrence and psychological distress in head and neck cancer patients and their carers. Psychooncology. https://doi.org/10.1002/pon.1346

    Article  PubMed  Google Scholar 

  38. Lerman C, Trock B, Rimer BK, Jepson C, Brody D, Boyce A (1991) Psychological side effects of breast cancer screening. Health Psychol. https://doi.org/10.1037/0278-6133.10.4.259

    Article  PubMed  Google Scholar 

  39. Trask PC et al (2001) Cancer-specific worry interference in women attending a breast and ovarian cancer risk evaluation program: impact on emotional distress and health functioning. Psychooncology. https://doi.org/10.1002/pon.510

    Article  PubMed  Google Scholar 

  40. Almeida SN, Elliott R, Silva ER, Sales CMD (2019) Fear of cancer recurrence: a qualitative systematic review and meta-synthesis of patients’ experiences. Clin Psychol Rev. https://doi.org/10.1016/j.cpr.2018.12.001

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology of Development and Socialization Processes, Sapienza University of Rome, Rome, Italy

    Andrea Chirico, Tommaso Palombi, Fabio Alivernini & Fabio Lucidi

  2. Academy of Cognitive Behavioral Sciences of Calabria (ASCoC), Lamezia Terme, Italy

    Deborah Vizza, Moira Valente, Melania Lo Iacono, Maria Rosita Campagna & Francesco Bruno

  3. Regional Neurogenetic Centre (CRN), Department of Primary Care, Azienda Sanitaria Provinciale Catanzaro, Viale A. Perugini, 88046, Lamezia Terme, CZ, Italy

    Francesco Bruno

Authors
  1. Andrea Chirico
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deborah Vizza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Moira Valente
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Melania Lo Iacono
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Rosita Campagna
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tommaso Palombi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fabio Alivernini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fabio Lucidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francesco Bruno
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, A.C., F.B., F.L., and D.V.; methodology, F.B., F.A., M.R.C., A.C., and F.L.; investigation, A.C., F.B., D.V., M.V., and M.L.I.; resources, A.C., F.B., and V.B.; data curation, A.C. and F.B.; writing (original draft preparation), T.P., A.C., F.B., and M.V.; writing (review and editing), A.C., T.P., F.L., F.A., and F.B.; All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Francesco Bruno.

Ethics declarations

Ethics approval

The study has been approved by the local Ethical Committee of Calabria Region-Area Centrale (#138799/2020). The patients/participants provided their written informed consent to participate in this study.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

A specific consent regarding publication was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chirico, A., Vizza, D., Valente, M. et al. Assessing the fear of recurrence using the Cancer Worry Scale in a sample of Italian breast cancer survivors. Support Care Cancer 30, 2829–2837 (2022). https://doi.org/10.1007/s00520-021-06718-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-021-06718-4

Keywords

Search

Navigation