Validation of the fear of cancer recurrence inventory-short form in long-term colorectal cancer survivors

BACKGROUND: The Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) is commonly used to categorize the severity of fear of cancer recurrence (FCR) defined as fear, worry, or concern about cancer returning or progressing. Evaluating the FCRI-SF factor structure and the clinical cut-off score in specific cancer populations and stages of survivorship is essential to determine its generalizability as a screening tool for clinical FCR. This study aimed to (1) examine the factor structure of the FCRI-SF, and (2) evaluate the clinical cut-off score in long-term colorectal cancer survivors without recurrence. METHODOLOGY: Data were drawn from a national cohort study on late effects after colorectal cancer and a randomized trial evaluating an online FCR intervention. Exploratory and confirmatory factor analyses were conducted to examine the latent structure of the FCRI-SF. The optimal theoretical cut-off was assessed using weighted logistic regression to estimate sensitivity and specificity. RESULTS: A total of 5,515 survivors completed the FCRI-SF, and 334 underwent clinical FCR assessment. Factor analyses indicated a one-factor solution, though model fit indices were suboptimal. Item 5 showed poor psychometric performance, and item 9 had a bimodal response pattern. The optimal theoretical cut-off score for identifying clinical FCR was 22. CONCLUSIONS: The FCRI-SF is a suitable tool for assessing FCR in long-term colorectal cancer survivors, but minor revisions to item 5 and item 9 may improve its psychometric properties.