Assessing the fear of recurrence using the Cancer Worry Scale in a sample of Italian breast cancer survivors

Abstract

Purpose: The fear of cancer recurrence (FCR) is one of the most reported problems by cancer survivors. A valid instrument to detect this issue could be useful to identify cancer survivors who are more vulnerable to developing FCR and related adverse outcomes (e.g., anxiety). The present study aimed to evaluate FCR in a sample of Italian breast cancer survivors using an Italian version of the 8-item Cancer Worry Scale (CWS) in order to establish a cut-off for the use in clinical settings.

Methods: The participants were 119 breast cancer survivors (mean age 47.7 years) at least 1 year after their primary treatment. An exploratory factor analysis (EFA) of CWS, internal reliability of CWS, concurrent and divergent validity using a bivariate correlation between the key measures of the study (i.e., FCR, anxiety, depression, fatigue, and self-efficacy), and ROC analysis of CWS were performed.

Results: Fit indices for the EFA were considered acceptable and showed a two-factor structure-labeled cancer worries and worries impact. The reliability of the two factors showed a Cronbach's alpha coefficient greater than 0.90. The CWS was positively related to anxiety, depression, fatigue, and negatively related to perceived self-efficacy. The best cut-off score was 24 versus 25, with a sensitivity of 74% and a specificity of 85%.

Conclusions: The CWS is a valid questionnaire to assess FCR among breast cancer survivors. The present study provides an overview of the relationship between CWS and the adverse outcomes related to FCR and coping strategies adopted to face it.

Keywords: Anxiety; Breast neoplasms; Cancer survivors; Depression; Factor analysis; ROC curve.