Fear of Cancer Recurrence Inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence

  • Sébastien Simard
  • Josée SavardEmail author
Original Article



Despite the fact that the fear of cancer recurrence is to varying degrees almost universal in cancer survivors, there is a lack of validated multidimensional instruments to evaluate this issue specifically.


The goal of this study was to develop and empirically validate a multidimensional self-report scale for assessing the fear of cancer recurrence, the Fear of Cancer Recurrence Inventory (FCRI).


A provincial medical databank was used to randomly select a pool of 1,704 French-Canadian patients who had been treated for breast, prostate, lung, and colorectal cancer within the past 10 years. Of these, 300 patients were asked to complete the FCRI on two occasions.


The factorial analysis conducted on the final 42-item scale revealed a seven-component solution (64% of the variance) including the following factors: triggers, severity, psychological distress, coping strategies, functioning impairments, insight, and reassurance. The results also supported the internal consistency (α = 0.95) and the temporal stability (r = 0.89) of the FCRI, as well as its construct validity with other self-report scales assessing fear of cancer recurrence (r = 0.68 to 0.77) or related constructs such as psychological distress (r = 0.43 to 0.77) and quality of life (r = −0.20 to −0.36).


This study suggests that the French-Canadian version of the FCRI is a reliable and valid instrument for evaluating the multidimensional aspects of the fear of cancer recurrence.


Fear of cancer recurrence Anxiety Cancer Questionnaire Validation 



The authors wish to acknowledge the important contribution of Jean-Marie Boisvert, Ph.D.; Lise Fillion, Ph.D.; Pierre Gagnon, M.D.; Catherine Gonthier; Jean-Philippe Gouin; Séverine Hervouet, M.Ps.; Robert Ladouceur, Ph.D.; Julie Maheux; Elizabeth Maunsell, Ph.D.; Josée Rhéaume, Ph.D.; Zeev Rosberger, Ph.D.; Annie Tremblay, M.D.; and Valérie Tremblay. This research was based on the Ph.D. dissertation of Sébastien Simard, M.Ps., conducted under the direction of Josée Savard, Ph.D. This study was funded by IDEA grants from the Canadian Prostate Cancer Research Initiative (no. 014420) and the Canadian Breast Cancer Research Alliance (no. 014459), as well as a studentship and a scientist award from the Canadian Institutes of Health Research awarded to the first and second author, respectively.


  1. 1.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, Haes dJCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F (1993) 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 85:365–376PubMedCrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DCGoogle Scholar
  3. 3.
    Anastasi A, Urbina S (1997) Psychological testing. Prentice-Hall, Upper Saddle River, NJGoogle Scholar
  4. 4.
    Baker F, Denniston M, Smith T, West MM (2005) Adult cancer survivors: how are they faring? Cancer 104:2565–2576PubMedCrossRefGoogle Scholar
  5. 5.
    Black EK, White CA (2005) Fear of recurrence, sense of coherence and posttraumatic stress disorder in haematological cancer survivors. Psychooncology 14:510–515PubMedCrossRefGoogle Scholar
  6. 6.
    Brunet A (1997) Épidémiologie des événements traumatiques et effets des expositions multiples chez des chauffeurs de bus urbains [Epidemiology of traumatic events and impact of multiple exposure among urban bus drivers]. Thesis, Département de psychologie, Université de Montréal, MontréalGoogle Scholar
  7. 7.
    Cella DF, Mahon SM, Donovan MI (1990) Cancer recurrence as a traumatic event. Behav Med 16:15–22PubMedGoogle Scholar
  8. 8.
    Clark DA (2005) Intrusive thoughts in clinical disorders: theory, research and treatment. Guilford, New YorkGoogle Scholar
  9. 9.
    Cronbach LJ (1984) Essentials of psychological testing. Harper and Row, New-YorkGoogle Scholar
  10. 10.
    Easterling DV, Leventhal H (1989) Contribution of concrete cognition to emotion: neutral symptoms as elicitors of worry about cancer. J Appl Psychol 74:787–796PubMedCrossRefGoogle Scholar
  11. 11.
    Fredette SL (1995) Breast cancer survivors: concerns and coping. Cancer Nurs 18:35–46PubMedCrossRefGoogle Scholar
  12. 12.
    Freeston MH, Ladouceur R, Thibodeau N, Gagnon F (1992) Cognitive intrusions in a non-clinical population: II. Associations with depressive, anxious, and compulsive symptoms. Behav Res Ther 30:263–271PubMedCrossRefGoogle Scholar
  13. 13.
    Gill KM, Mishel M, Belyea M, Germino B, Germino LS, Porter L, LaNey IC, Stewart J (2004) Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors. Oncol Nurs Forum 31:633–639PubMedCrossRefGoogle Scholar
  14. 14.
    Gotay CC, Pagano IS (2007) Assessment of Survivor Concerns (ASC): a newly proposed brief questionnaire. Health Qual Life Outcomes 5:1–11CrossRefGoogle Scholar
  15. 15.
    Greenberg DB, Kornblith AB, Herndon JE, Zuckerman E, Schiffer CA, Weiss RB, Mayer RJ, Wolchok SM, Holland JC (1997) Quality of life for adult leukemia survivors treated on clinical trials of Cancer and Leukemia Group B during the period 1971–1988: predictors for later psychologic distress. Cancer 80:1936–1944PubMedCrossRefGoogle Scholar
  16. 16.
    Herschbach P, Berg P, Dankert A, Duran G, Engst-Hastreiter U, Waadt S, Keller M, Ukat R, Henrich G (2005) Fear of progression in chronic diseases: psychometric properties of the Fear of Progression Questionnaire. J Psychosom Res 58:505–511PubMedCrossRefGoogle Scholar
  17. 17.
    Herschbach P, Keller M, Knight L, Brandl T, Huber B, Henrich G, Marten-Mittag B (2004) Psychological problems of cancer patients: a cancer distress screening with a cancer-specific questionnaire. B J Cancer 91:504–511CrossRefGoogle Scholar
  18. 18.
    Hilton BA (1988) The relationship of uncertainty, control, commitment, and threat of recurrence to coping strategies used by women diagnosed with breast cancer. J Behav Med 12:39–54CrossRefGoogle Scholar
  19. 19.
    Horowitz M, Wilner N, Alvarez W (1979) Impact of event scale: a measure of subjective stress. Psychosom Med 41:209–218PubMedGoogle Scholar
  20. 20.
    Humphris GM, Rogers S, McNally D, Lee-Jones C, Brown J, Vaughan D (2003) Fear of recurrence and possible cases of anxiety and depression in orofacial cancer patients. Int J Oral Maxillofac Sur 32:486–491Google Scholar
  21. 21.
    King MT, Kenny P, Shiell A, Hall J, Boyages J (2000) Quality of life three months and one year after first treatment for early stage breast cancer: influence of treatment and patient characteristics. Qual Life Res 9:789–800PubMedCrossRefGoogle Scholar
  22. 22.
    Langlois F, Ladouceur R (2004) Adaptation of GAD treatment for hypochondriasis. Cogn Behav Pract 11:393–404CrossRefGoogle Scholar
  23. 23.
    Lasry J-CM, Margolese RG (1992) Fear of recurrence, breast-conserving surgery, and the trade-off hypothesis. Cancer 69:2111–2115PubMedCrossRefGoogle Scholar
  24. 24.
    Leake RL, Gurrin LC, Hammond IG (2001) Quality of life in patients attending a low-risk gynaecological oncology follow-up clinic. Psychooncology 10:428–435PubMedCrossRefGoogle Scholar
  25. 25.
    Lee-Jones C, Humphris G, Dixon R, Hatcher MB (1997) Fear of cancer recurrence—a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. Psychooncology 6:95–105PubMedCrossRefGoogle Scholar
  26. 26.
    Maneesriwongul W, Dixon JK (2004) Instrument translation process: a methods review. J Adv Nurs 48:175–186PubMedCrossRefGoogle Scholar
  27. 27.
    Mehta SS, Lubeck DP, Pasta DJ, Litwin MS (2003) Fear of cancer recurrence in patients undergoing definitive treatment for prostate cancer: results from CaPSURE. J Urol 170:1931–1933PubMedCrossRefGoogle Scholar
  28. 28.
    Mellon S, Kershaw TS, Northouse LL, Freeman-Gibb L (2007) A family-based model to predict fear of recurrence for cancer survivors and their caregivers. Psychooncology 16:214–223PubMedCrossRefGoogle Scholar
  29. 29.
    Meyer L, Aspegren K (1989) Long-term psychological sequelae of mastectomy and breast conserving treatment for breast cancer. Acta Oncol 28:13–18PubMedCrossRefGoogle Scholar
  30. 30.
    Moyer A (1997) Psychosocial outcomes of breast-conserving surgery versus mastectomy: a meta-analytic review. Health Psychol 16:284–298PubMedCrossRefGoogle Scholar
  31. 31.
    National Cancer Institute of Canada (2006) Canadian cancer statistics 2006. National Cancer Institute of Canada, TorontoGoogle Scholar
  32. 32.
    Northouse LL (1981) Mastectomy patients and the fear of cancer recurrence. Cancer Nurs 4:227–230CrossRefGoogle Scholar
  33. 33.
    Polinsky ML (1994) Functional status of long-term breast cancer survivors: demonstrating chronicity. Health Soc Work 19:165–173PubMedGoogle Scholar
  34. 34.
    Ries LAG, Melbert D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, Clegg L, Horner MJ, Howlader N, Eisner MP, Reichman M, Edwards BK (2007) SEER cancer statistics review, 1975–2004. National Cancer Institute, Bethesda, MDGoogle Scholar
  35. 35.
    Robbins JM, Kirmayer LJ (1996) Transient and persistent hypochondrical worry in primary care. Psychol Med 26:575–589PubMedCrossRefGoogle Scholar
  36. 36.
    Savard J, Laberge B, Gauthier JG, Ivers H, Bergeron MG (1998) Evaluating anxiety and depression in HIV-infected patients. J Pers Assess 71:349–367PubMedCrossRefGoogle Scholar
  37. 37.
    SPSS (1999) Statistical package for the social sciences. SPSS, Chicago, ILGoogle Scholar
  38. 38.
    Stanton AL, Danoff-Burg S, Huggins ME (2002) The first year after breast cancer diagnosis: Hope and coping strategies as predictors of adjustment. Psychooncology 11:93–102PubMedCrossRefGoogle Scholar
  39. 39.
    Stefanek ME, Shaw A, DeGeorge D (1989) Illness-related worry among cancer patients: prevalence, severity, and content. Cancer Invest 7:365–371PubMedCrossRefGoogle Scholar
  40. 40.
    Tabachnik BG, Fidell LS (2001) Using multivariate statistics. Harper Collins, New YorkGoogle Scholar
  41. 41.
    Vickberg SM (2003) The Concerns About Recurrence Scale (CARS): a systematic measure of womens fears about the possibility of breast cancer recurrence. Ann Behav Med 25:16–24PubMedCrossRefGoogle Scholar
  42. 42.
    Vickberg SM (2001) Fears about breast cancer recurrence: interviews with a diverse sample. Cancer Pract 9:237–243CrossRefGoogle Scholar
  43. 43.
    Welch-McCaffrey D, Hoffman B, Leigh SA, Loescher LJ, Meyskens FL (1989) Surviving adult cancers. Part 2: psychological implications. Ann Intern Med 111:517–524PubMedGoogle Scholar
  44. 44.
    Wong CA, Bramwell L (1992) Uncertainty and anxiety after mastectomy for breast cancer. Cancer Nurs 15:363–371PubMedCrossRefGoogle Scholar
  45. 45.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.School of PsychologyLaval UniversityQuébecCanada
  2. 2.Laval University Cancer Research CenterQuébecCanada

Personalised recommendations