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Screening and comorbidity of clinical levels of fear of cancer recurrence

Journal of Cancer Survivorship volume 9, pages 481–491 (2015)Cite this article

Abstract

Purpose

The prevalence of clinical levels of fear of cancer recurrence (FCR) in cancer survivors is unknown, which may be partly explained by the lack of an assessment method that would make it possible to distinguish between normal and clinical levels of FCR. Moreover, despite the apparent overlap between FCR and manifestations of some psychiatric disorders, no study has yet evaluated the comorbidity of clinical levels of FCR. The goals of this study were to assess the capacity of the Fear of Cancer Recurrence Inventory severity subscale, to consider a shorter form of the FCRI (FCRI-SF), to screen for clinical levels of FCR, and to assess its psychiatric comorbidity.

Methods

Sixty French-Canadian cancer survivors (73 % of those eligible) who had been treated within the past 4 years for localized breast, prostate, lung, or colorectal cancer were randomly selected. Participants were administered a clinical interview assessing FCR, the Structured Clinical Interview for DSM-IV, and self-report scales.

Results

A cutoff score of 13 or higher on the FCRI-SF was associated with optimal sensitivity (88 %) and specificity (75 %) rates for the screening of clinical levels of FCR. Cancer survivors with clinical levels of FCR were significantly more likely to meet the criteria for a current psychiatric disorder (60 %) than patients with nonclinical levels (29 %). Anxiety disorders tended to be the most common comorbid disorders.

Conclusions/Implications for Cancer Survivors

The FCRI-SF allows rapid and effective screening of clinical levels of FCR, a condition associated with significant psychiatric comorbidity.

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Acknowledgments

This study was funded by IDEA grants from the Canadian Prostate Cancer Research Initiative and the Canadian Breast Cancer Research Alliance, as well as a studentship from the Canadian Institutes of Health Research.

Conflict of interest

The authors have no conflicts of interest. The contents of this manuscript have not been copyrighted or published previously.

Author information

Affiliations

  1. Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), 2725, Chemin Ste-Foy, Québec, G1V 4G5, QC, Canada

    Sébastien Simard

  2. Nursing Faculty, Université Laval, Québec, QC, Canada

    Sébastien Simard

  3. School of Psychology, Université Laval, Québec, QC, Canada

    Josée Savard

  4. Laval University Cancer Research Center, Québec, QC, Canada

    Josée Savard

Authors
  1. Sébastien Simard
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  2. Josée Savard
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Corresponding author

Correspondence to Sébastien Simard.

Appendix

Appendix

Semi-structured Interview on Fear of Cancer Recurrence (SIFCR)

Introduction

Can you tell me the most troubling thought (i.e., internal speech, reflection, internal questioning) or image (i.e., flashback, picture or movie in your head) you have had in the last month? Describe this thought or image.

Fear of cancer recurrence

  1. 1.

    Do you ever have thoughts or images about cancer? Describe this thought or image.

  2. 2.

    Do you ever have thoughts or images about the possibility of cancer recurrence (i.e., the return or progression of cancer in the same place or in another part of your body) or about the consequences of cancer recurrence? Describe this thought or image.

    Referring to the thought or image described:

  3. 3.

    How long have you had this kind of thought or image?

  4. 4.

    At what frequency have you experienced this thought or image?

  5. 5.

    How much time can the thought or image last?

  6. 6.

    In general, in what form does it appear? ____ %Thought ____% Image

  7. 7.

    What can trigger this thought/image?

  8. 8.

    What makes the thought/image more present or stronger?

  9. 9.

    What makes the thought/image less present or weaker?

  10. 10.

    What strategies do you use to avoid this thought/image?

  11. 11.

    What strategies do you use to control or get rid of this thought/image?

  12. 12.

    How effective are these strategies?

  13. 13.

    How do you feel when you experience this thought/image? What is your reaction?

  14. 14.

    What is the consequence of this thought/image on your life (i.e., everyday activities, work, level of functioning)?

  15. 15.

    To what extent do you think the thought/image could occur or be true?

    If neither thoughts nor images about cancer recurrence have been identified, the presence of avoidance or denial must be assessed:

  16. 16.

    How do you explain that you have not had any thoughts or images linked to the cancer?

  17. 17.

    What do you do to prevent thoughts or images linked to the cancer from occurring?

  18. 18.

    What strategies would you share with others coping with cancer that experience intrusive thoughts and negative images?

Severity of fear of cancer recurrence based on the interview

The interviewer had to determine the severity of the patient’s FCR level on the following 10-point Likert scale. A score of 5 or greater was considered to be indicative of clinical levels of FCR.

  1. 0

    Don’t think about it, no avoidance, no disturbance associated

  2. 1–2

    Don’t think about it, efforts to dismiss, no disturbance associated

  3. 3–4

    Rarely think about it, efforts to dismiss, low emotional disturbance, no functional impairment

  4. 5–6

    Sometimes think about it, efforts to dismiss, moderate emotional disturbance, low functional impairment

  5. 7–8

    Think about it a great deal, efforts to dismiss, high emotional disturbance, moderate functional impairment

  6. 9–10

    Think about it constantly, efforts to dismiss, high emotional disturbance, high functional impairment

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Simard, S., Savard, J. Screening and comorbidity of clinical levels of fear of cancer recurrence. J Cancer Surviv 9, 481–491 (2015). https://doi.org/10.1007/s11764-015-0424-4

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Keywords

  • Cancer
  • Fear of cancer recurrence
  • Fear of progression
  • Screening
  • Clinical levels
  • Comorbidity
  • Psychiatric disorders