A multidimensional scale to measure the reproductive concerns of young adult female cancer survivors

Abstract

Purpose-Concerns about fertility and parenthood are important to many young adult (YA) female cancer survivors and are associated with poorer quality of life. We aimed to develop a new scale to comprehensively measure these concerns so that they can be better addressed.Methods-Scale development involved: 1) seven focus groups to identify reproductive concerns among YA female cancer survivors and develop potential scale items followed by pilot testing and cognitive interviews to refine items, 2) administering surveys to 204 YA female survivors and conducting principal components analysis (PCA) with oblique rotation to identify underlying factors in the multidimensional scale, and 3) identification of preliminary construct validity evidence.Results-We subjected 37 potential scale items to PCA, which indicated a six-factor solution. After removing low-loading and cross-loading items, we selected the three top loading items representing each factor. The 18-item Reproductive Concerns After Cancer (RCAC) scale (α = 0.82) assesses concerns about fertility potential, partner disclosure, child's health, personal health, acceptance, and becoming pregnant. As hypothesized, women who wanted to have a baby (p < 0.001) and those for whom having a biological child was very important (p < 0.05) had higher mean scores, indicating higher concerns.Conclusions-The scale demonstrated good internal consistency and evidence of construct validity and holds promise for future clinical and research applications.Implications for Cancer Survivors-An effective tool to identify concerns related to fertility and parenthood is essential for meeting the long-term reproductive health needs of young women who have survived cancer.

Revisiting the Reproductive Concerns After Cancer (RCAC) scale

“…This largely replicates findings from the original developmental study. 7 The lack of statistical support in this study for the one-factor and higher-order models suggest that the RCAC scale may be best represented as a profile of subscale scores, rather than as a total score.…”

“…The mean score for the fertility potential subscale was most comparable (3.59 vs 3.62 in the present sample), and the mean score for partner disclosure was the most dissimilar (3.15 vs 2.49 in the present sample). 7 The omega total and Revelle omega total coefficients for all but one of the subscales were in the good range (.74 to .87).…”

“…The Reproductive Concerns After Cancer (RCAC) scale was developed to allow researchers and clinicians to identify the range of fertility and childbearing concerns and unmet needs that RAFCS experience. 7 The RCAC scale is an 18-item selfreport scale with six three-item subscales assessing the following areas of concern: fertility potential, partner disclosure of fertility status, child's health, personal health, acceptance of possible infertility, and becoming pregnant. It was developed based on qualitative analysis of focus groups and individual interviews with young adult female cancer survivors who were 18 to 34 years of age.…”

“…2,14,20,25,26 However, the psychometric properties have only been evaluated in the original development sample of female survivors who were 18 to 35 years of age. 7 The first aim of the present study was to examine the structural validity of the six-factor model of the RCAC scale using confirmatory factor analysis (CFA) in a separate sample of reproductive-aged female survivors, defined as younger than age 45. We examined three models: 1) a one-factor model representing the total score; 2) a higher order model with one second-order factor, representing the total score, and six first-order assessed, when they were younger than age 45 (72% of 332 enrolled at baseline).…”

Clinician provision of oncofertility support in cancer patients of a reproductive age: A systematic review

“…Cancer patients hold concerns regarding their fertility throughout the whole cancer journey, from diagnosis, throughout treatment and into survivorship, [22][23][24] and at each of these time points, their concerns and consequent care needs may change depending on patient age, 25 gender, 26 or child-bearing status. 27 Moreover, as young adult cancer patients rate both fertility information 28 and post-treatment fertility 26 to be of high importance, a better understanding of services offered by clinicians and rates of referral for oncofertility support is warranted to assure that patients' support needs are met across the whole reproductive age.…”