Spotlight on the Fear of Cancer Recurrence Inventory (FCRI)

Abstract

Fear of cancer recurrence (FCR) is a pervasive concern for people living with cancer. The rapidly expanding FCR literature has been weakened somewhat by use of miscellaneous FCR measures of varying quality. The Fear of Cancer Recurrence Inventory (FCRI) has been widely used in observational and intervention studies and the FCRI severity subscale, also known as the FCRI-Short Form (FCRI-SF), is often used to identify potential cases of clinically significant FCR. Given the FCRI’s increasing use in research and clinical practice, we aimed to provide an overview, critique, and suggested improvements of the FCRI. Studies citing the original FCRI validation paper were identified and synthesised using narrative and meta-analytic methods. The 42-item FCRI has demonstrated a reasonably robust 7-factor structure across evaluations in multiple languages, although certain subscales (eg, Coping) demonstrate sub-optimal reliability. Confirmation of the cross-cultural equivalence of several FCRI translations is needed. Meta-analysis of FCRI-SF scores revealed a combined weighted mean score of 15.7/36, a little above the lowest proposed cut-off score (≥13) for clinical FCR. Depending on the FCRI-SF cut-off used, between 30.0% and 53.9% of the cancer population (ie, patients and survivors) appear to experience sub-clinical or clinical FCR. Higher FCRI scores were associated with younger age and female gender, pain/physical symptoms and psychological morbidity, consistent with the FCR literature generally. Issues regarding the application and interpretation of the FCRI remain. Whether the FCRI is well suited to assessing fear of progression as well as recurrence is unclear, the meaningfulness of the FCRI total score is debatable, and the use of the FCRI-SF to screen for clinical FCR is problematic, as items do not reflect established characteristics of clinical FCR. Refinement of the FCRI is needed for it to remain a key FCR assessment tool in future research and clinical practice.

A systematic review of fear of cancer recurrence related healthcare use and intervention cost‐effectiveness

“…Most studies used the Fear of Cancer Recurrence Inventory (FCRI) 25,26,28,29,32,35 . The FCRI is a widely used 42‐item multi‐dimensional FCR measure with strong psychometric properties 36,37 . One study did not use a validated FCR measure 30 .…”

Identifying the ‘Active Ingredients' of an Effective Psychological Intervention to Reduce Fear of Cancer Recurrence: A Process Evaluation

“…This study showed that people with higher levels of FCR at baseline reported the greatest decrease in FCR post-intervention; however, there is currently no consensus regarding what cut-off score constitutes “high” FCR, nor what score is indicative of referral for intervention. Brief measurement tools have shown promise and may reduce the cognitive burden on patients while quickly identifying those with greatest clinical need (Fardell et al, 2018 ; Rudy et al, 2020 ; Smith et al, 2020 ). Further research to identify a clinically-meaningful FCR cut-off score for people affected by melanoma will allow for pre-intervention screening and more precise targeting of treatments and interventions (Lebel et al, 2017 ).…”

Which Head and Neck Cancer Patients Are Most at Risk of High Levels of Fear of Cancer Recurrence

“…For example, the Mirosevic et al article (Mirosevic et al, 2019) set their cut-off against the validated Fears of Cancer Recurrence Inventory (FCRI). A review of the FCRI has raised concerns about the low cut-off on this measure (Smith et al, 2020). Hence, careful attention needs to be paid to the actual wording and psychometric properties of the measures used.…”