Skip to main content


Log in

Initial validation of the Danish version of the Fear of Cancer Recurrence Inventory (FCRI) in colorectal cancer patients

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript



The Fear of Cancer Recurrence Inventory (FCRI) is a multidimensional measure for fear of cancer recurrence (FCR). The aim of this study was to assess the psychometric properties of the translated Danish version of the FCRI in a population of colorectal cancer patients.


The English version of the FCRI was forward–backward translated into Danish and pilot tested in a gynaecological cancer population. The psychometric properties of the FCRI were assessed in terms of responsiveness, test–retest reliability and discriminative and convergent validity in a population of colorectal cancer patients by asking them to complete questionnaires at three time points during follow-up. Clinical FCR was defined as ≥ 16 at the FCRI short form.


The participation rate was 57%. A low association was found between higher scores on the FCRI and younger age (r = − 0.29, p = 0.02). A moderate correlation was found between the FCRI score and a measure for worry traits (r = 0.49, p < 0.001). Mean difference in total FCRI score was statistically significant between ‘pre-scan’ and ‘postscan’ (p < 0.001), thus indicating that the FCRI was responsive to change. The FCRI score showed good test–retest reliability (intraclass correlation = 0.84).


The Danish version of the FCRI is a reliable and responsive measure for FCR in colorectal cancer patients and shows acceptable discriminative and convergent validity.

Implications for Cancer Survivors

A valid measure for FCR is crucial in order to identify patients with a need for special attention or interventions for high levels of FCR and to improve future research into FCR among cancer survivors.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Armes J, Crowe M, Colbourne L, Morgan H, Murrells T, Oakley C, et al. Patients’ supportive care needs beyond the end of cancer treatment: a prospective, longitudinal survey. J Clin Oncol. 2009;27(36):6172–9.

    Article  Google Scholar 

  2. Mikkelsen T, Sondergaard J, Sokolowski I, Jensen A, Olesen F. Cancer survivors’ rehabilitation needs in a primary health care context. Fam Pract. 2009;26(3):221–30.

    Article  Google Scholar 

  3. Simard S, Thewes B, Humphris G, Dixon M, Hayden C, Mireskandari S, et al. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv. 2013 Sep;7(3):300–22.

    Article  Google Scholar 

  4. Lebel S, Ozakinci G, Humphris G, Mutsaers B, Thewes B, Prins J, et al. From normal response to clinical problem: definition and clinical features of fear of cancer recurrence. Support Care Cancer. 2016;24:3265–8.

    Article  Google Scholar 

  5. Simard S, Savard J, Ivers H. Fear of cancer recurrence: specific profiles and nature of intrusive thoughts. J Cancer Surviv. 2010;4(4):361–71.

    Article  Google Scholar 

  6. Butow PN, Fardell JE, Smith AB. Fear of cancer recurrence: an overview and Australian perspective. Cancer Forum. 2015;39(2):95–100.

    Google Scholar 

  7. Deimling GT, Bowman KF, Sterns S, Wagner LJ, Kahana B. Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psychooncology. 2006;15(4):306–20.

    Article  Google Scholar 

  8. Crist JV, Grunfeld EA. Factors reported to influence fear of recurrence in cancer patients: a systematic review. Psychooncology. 2013;22(5):978–86.

    Article  Google Scholar 

  9. Diefenbach M, Mohamed NE, Horwitz E, Pollack A. Longitudinal associations among quality of life and its predictors in patients treated for prostate cancer: the moderating role of age. Psychol Health Med. 2008;13(2):146–61.

    Article  Google Scholar 

  10. Kornblith AB, Powell M, Regan MM, Bennett S, Krasner C, Moy B, et al. Long-term psychosocial adjustment of older vs younger survivors of breast and endometrial cancer. Psychooncology. 2007;16(10):895–903.

    Article  Google Scholar 

  11. Yang Y, Cameron J, Humphris G. The relationship between cancer patient’s fear of recurrence and radiotherapy: a systematic review and meta-analysis. Psychooncology. 2017;26(6):738–46.

    Article  Google Scholar 

  12. Llewellyn CD, Weinman J, McGurk M, Humphris G. Can we predict which head and neck cancer survivors develop fears of recurrence? J Psychosom Res. 2008;65(6):525–32.

    Article  Google Scholar 

  13. Freeman-Gibb LA, Janz NK, Katapodi MC, Zikmund-Fisher BJ, Northouse L. The relationship between illness representations, risk perception and fear of cancer recurrence in breast cancer survivors. Psychooncology. 2017;26(9):1270–7.

    Article  Google Scholar 

  14. Gill KM, Mishel M, Belyea M, Germino B, Germino LS, Porter L, et al. Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors. Oncol Nurs Forum. 2004;31(3):633–9.

    Article  Google Scholar 

  15. Janz NK, Hawley ST, Mujahid MS, Griggs JJ, Alderman A, Hamilton AS, et al. Correlates of worry about recurrence in a multiethnic population-based sample of women with breast cancer. Cancer. 2011;117(9):1827–36.

    Article  Google Scholar 

  16. Mehnert A, Berg P, Henrich G, Herschbach P. Fear of cancer progression and cancer-related intrusive cognitions in breast cancer survivors. Psychooncology. 2009;18(12):1273–80.

    Article  Google Scholar 

  17. Thewes B, Butow P, Zachariae R, Christensen S, Simard S, Gotay C. Fear of cancer recurrence: a systematic literature review of self-report measures. Psychooncology. 2012;21(6):571–87.

    Article  Google Scholar 

  18. Simard S, Savard J. Fear of Cancer Recurrence Inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer. 2009;17(3):241–51.

    Article  Google Scholar 

  19. Lebel S, Simard S, Harris C, Feldstain A, Beattie S, McCallum M, et al. Empirical validation of the English version of the Fear of Cancer Recurrence Inventory. Qual Life Res. 2016;25(2):311–21.

    Article  Google Scholar 

  20. Shin J, Goo A, Ko H, Kim JH, Lim SU, Lee HK, et al. Validation study for the Korean version of Fear of Cancer Recurrence Inventory. J Korean Med Sci. 2017;32(11):1792–9.

    Article  Google Scholar 

  21. van Helmondt SJ, van der Lee ML, de Vries J. Translation and validation of the Dutch version of the Fear of Cancer Recurrence Inventory (FCRI-NL). J Psychosom Res. 2017;102:21–8.

    Article  Google Scholar 

  22. Simard S, Savard J. Screening and comorbidity of clinical levels of fear of cancer recurrence. J Cancer Surviv. 2015;9(3):481–91.

    Article  Google Scholar 

  23. Leeson SC, Beaver K, Ezendam NPM, Mačuks R, Martin-Hirsch PL, Miles T, et al. The future for follow-up of gynaecological cancer in Europe. Summary of available data and overview of ongoing trials. Eur J Obstet Gynecol Reprod Biol. 2017;210(Supplement C):376–80.

    Article  CAS  Google Scholar 

  24. Hovdenak Jakobsen I, Juul T, Bernstein I, Christensen P, Jensen FS, Johansen C, et al. Follow-up after rectal cancer: developing and testing a novel patient-led follow-up program. Study Protocol Acta Oncol. 2017;56(2):307–13.

    Article  Google Scholar 

  25. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186–91.

    Article  CAS  Google Scholar 

  26. Cull A, Sprangers MA, Bjordal K, Aaronson N. On behalf of the European Organisation for Research and Treatment of Cancer quality of life study group. EORTC quality of life study group translation procedure. Brussels: EORTC; 1998. p. 26.

  27. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19(4):539–49.

    Article  Google Scholar 

  28. Postoperativ kontrol. In: DCCG’s nationale retningslinjer for diagnostik og behandling af kolorektal cancer. Danish Colorectal Cancer Group. 2012. Accessed 10 Dec 2016.

  29. Meyer TJ, Miller ML, Metzger RL, Borkovec TD. Development and validation of the Penn State Worry Questionnaire. Behav Res Ther. 1990;28(6):487–95.

    Article  CAS  Google Scholar 

  30. Anthoine E, Moret L, Regnault A, Sebille V, Hardouin JB. Sample size used to validate a scale: a review of publications on newly-developed patient reported outcomes measures. Health Qual Life Outcomes. 2014;12

  31. Dinkel A, Kremsreiter K, Marten-Mittag B, Lahmann C. Comorbidity of fear of progression and anxiety disorders in cancer patients. Gen Hosp Psychiatry. 2014;36(6):613–9.

    Article  Google Scholar 

  32. Hvenegaard M, Watkins ER, Poulsen S, Rosenberg NK, Gondan M, Grafton B, et al. Rumination-focused cognitive behaviour therapy vs. cognitive behaviour therapy for depression: study protocol for a randomised controlled superiority trial. Trials. 2015;16

  33. Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess. 1994;6(4):284–90.

    Article  Google Scholar 

  34. de Vet HC, Terwee CB, Mokkink LB, Knol DL. Validity. In: de Vet HC, Terwee CB, Mokkink LB, Knol DL, editors. Measurement in medicine. First ed. Cambridge: Cambridge University Press; 2011. p. 150–201.

    Chapter  Google Scholar 

  35. Korte KJ, Allan NP, Schmidt NB. Factor mixture modeling of the Penn State Worry Questionnaire: evidence for distinct classes of worry. J Anxiety Disord. 2016;37:40–7.

    Article  Google Scholar 

  36. Lampic C, Wennberg A, Schill JE, Brodin O, Glimelius B, Sjoden PO. Anxiety and cancer-related worry of cancer patients at routine follow-up visits. Acta Oncol. 1994;33(2):119–25.

    Article  CAS  Google Scholar 

  37. Papagrigoriadis S, Heyman B. Patients’ views on follow up of colorectal cancer: implications for risk communication and decision making. Postgrad Med J. 2003;79(933):403–7.

    Article  CAS  Google Scholar 

  38. Stiggelbout AM, de Haes JC, Vree R, van de Velde CJ, Bruijninckx CM, van Groningen K, et al. Follow-up of colorectal cancer patients: quality of life and attitudes towards follow-up. Br J Cancer. 1997;75(6):914–20.

    Article  CAS  Google Scholar 

  39. Custers JA, Gielissen MF, Janssen SH, de Wilt JH, Prins JB. Fear of cancer recurrence in colorectal cancer survivors. Support Care Cancer. 2016;24(2):555–62.

    Article  Google Scholar 

  40. Custers JA, van den Berg SW, van Laarhoven HW, Bleiker EM, Gielissen MF, Prins JB. The Cancer Worry Scale: detecting fear of recurrence in breast cancer survivors. Cancer Nurs. 2014;37(1):44–50.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ida Hovdenak Jakobsen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Requests for permission to use the FCRI (any language versions) should be addressed to Sébastien Simard:

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hovdenak Jakobsen, I., Jeppesen, M.M., Simard, S. et al. Initial validation of the Danish version of the Fear of Cancer Recurrence Inventory (FCRI) in colorectal cancer patients. J Cancer Surviv 12, 723–732 (2018).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: