Poster Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Comparative validity, responsiveness, and minimally important difference of fear of cancer recurrence scales in breast cancer survivors (126454)

Stella Snyder 1 , Ekin Secinti 2 , Kurt Kroenke 3 4 , Catherine E Mosher 1 , Shelley A Johns 3 4
  1. Indiana University Indianapolis, Indianapolis, INDIANA, United States
  2. Eli Lilly and Company, Indianapolis, Indiana, United States
  3. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
  4. Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana, United States

Objectives/purpose:

Fear of cancer recurrence (FCR) is a prevalent and distressing concern among breast cancer survivors. Despite widespread use of five FCR measures—the Fear of Cancer Recurrence Inventory (FCRI; total and severity short form), FCR-7, FCR-4, and Concerns About Recurrence Scale (CARS)—no gold standard has emerged, and few studies have evaluated them side by side in intervention trials. This study assessed reliability, validity, responsiveness, minimally important difference (MID), and discriminative accuracy of these measures.

Sample and setting:

Secondary data were used from a U.S.-based, three-arm randomized controlled trial (NCT05364450) comparing Acceptance and Commitment Therapy, Cognitive Behavioral Therapy, and enhanced usual care. Participants (N=384; planned accrual=390; mean age=55.8 years) were women with stage I–IIIA breast cancer (completed treatment ≤5 years prior to enrollment; screened positive for clinical FCR). Most were non-Hispanic White (80.5%) or Black (13.8%) and college-educated (61.2%).

Procedures:

Baseline and post-intervention data were analyzed. Internal consistency (α), convergent and construct validity (r), standardized response means (SRMs), between-group effect sizes, MID estimates (anchor- and distribution-based), and area under the curve (AUC) values were examined. A post-intervention participant-reported global FCR improvement item was used for anchor-based analyses to classify participants as “Worse,” “Same,” or “Better.”

Results:

All measures demonstrated acceptable internal consistency (αs=0.70–0.93) and convergent validity (rs=0.73–0.94). Construct validity was demonstrated by small to moderate correlations with related symptoms and quality of life. All measures differentiated participants reporting global FCR improvement at post-intervention from those unchanged (SRMs=0.73-0.84). Between-group effect sizes were small (0.21-0.32) and similar for shorter and longer measures. MID estimates ranged from 1 (FCR-4) to 7 (FCRI-Total). AUCs showed comparable accuracy across measures in detecting any and significant global improvement.

Conclusion and clinical implications:

FCRI-Total, FCRI-Severity, FCR-7, FCR-4, and CARS are valid, reliable, and responsive tools for assessing meaningful FCR change in clinical trials and survivorship care.