Objectives/purpose: Sarcoma is a rare cancer affecting connective tissue. Survivors face high treatment burden, significant risk of metastasis and recurrence, and poor long-term outcomes. Survivors often report higher psychological distress and fear of recurrence compared to other cancers. We aimed to (i) psychometrically validate the Fear of Cancer Recurrence Inventory (FCRI) for sarcoma and (ii) describe the psychological profile of patients with sarcoma.
Sample and Setting: We undertook secondary analysis of data from a large cross-sectional online survey completed by 229 UK-based adults with sarcoma.
Procedures: Participants completed a self-report questionnaire assessing: anxiety, depression, stress, fear of recurrence, post-traumatic growth, psychological flexibility, social support, disability, and quality of life.
Results: The FCRI demonstrated: (i) acceptable to good internal consistency; (ii) strong convergent validity; (iii) moderate concurrent validity; and, (iv) strong incremental validity in predicting psychological outcomes. However, construct validity demonstrated several issues, including poor factor loading (4 items), cross-loading (3 items), and multidimensionality of the coping strategies subscale. After correction we improved model fit to acceptable levels (CFI = .922; TLI = .912; RMSEA = .059; SRMR = .059).
Poorer psychological outcomes were best predicted by younger age, female gender, and relationship and employment status. Clinically predictive factors included tumour type, site, treatment modality, amputation, and recurrence. Findings were not straightforward, however, with different variables predictive of different types of outcome. In analysing post-traumatic growth, we identified fear of recurrence, quality of life, social support, and disability as significant predictors.
Conclusion and Clinical Implications: This study provides novel insights into the psychological profile of people with sarcoma. It highlights the importance of tailored assessment tools, the vast range of psychosocial challenges experienced by this cancer group, and key predictors of post-traumatic growth. We further identified likely psychological mechanisms and processes to include in supportive care interventions to improve psychological wellbeing.