Are fear of cancer recurrence and fear of progression equivalent constructs?

Abstract

Background The predominant definition of fear of cancer recurrence (FCR) conflates FCR with fear of progression (FOP). However, this assumption has never been tested. Importantly, if FCR and FOP are distinct and have different predictors, existing interventions for FCR may not be equally effective for survivors who fear progression rather than recurrence of their disease. The present study aimed to determine whether FCR and FOP are empirically equivalent; and whether they are predicted by the same theoretically derived variables. Methods Three hundred and eleven adults with a history of breast or ovarian cancer were analysed (n = 209, 67% in remission). Exploratory factor analysis was conducted on the items of the FCR Inventory severity subscale and short‐form FOP Questionnaire together. Structural equation modelling was conducted to predict FCR and FOP and determine whether theoretical models accounted equally well for both constructs, and whether models were equally relevant to those with and without current disease. Findings The factor analysis demonstrated that the FCR Inventory severity subscale and the short‐form FOP Questionnaire loaded onto distinct, but related, factors which represented FCR and FOP. Structural modelling indicated that risk perception and bodily threat monitoring were more strongly associated with FCR than FOP. However, both FCR and FOP were associated with metacognitions and intrusions. Interpretation These findings suggest that whilst FCR and FOP are related with some overlapping predictors, they are not the same construct. Hence, it is necessary to ensure that in clinical practice and research these constructs are considered separately.

Does interpretation bias moderate the relationship between pain and fear of cancer recurrence?

“…Prevailing definitions of FCR conflate these two constructs (Lebel et al, 2016); however, the current results suggest that interpretation biases only moderate the relationship between pain and FCR, not pain and FOP. Recent research confirms that FCR and FOP should be considered separately (Coutts-Bain et al, 2022) and may represent two different aspects of fear in FOP in other illnesses (Sharpe et al, 2022).…”

The bodily threat monitoring scale: Development and preliminary validation in adult and childhood cancer survivors

“…Three‐hundred and six respondents completed the BTMS and were included in analyses (breast N = 147; ovarian N = 159). Data from subsamples have been reported elsewhere 20,21 . The study received approval from the University of Sydney Human Research Ethics Committee.…”

“…Data from subsamples have been reported elsewhere. 20,21 The study received approval from the University of Sydney Human Research Ethics Committee. Participants provided informed consent online.…”

Relationship between fear of progression and symptom burden, disease factors and social/family factors in patients with stage‐IV breast cancer in Shandong, China

“…21,22 However, from the oncological perspective, the two are different. 23 FCR may be applicable to patients with early-stage cancer, especially those who have undergone surgical resection of the lesion; they may have a sense of fear of the disease before having experienced a relapse. FoP may be applicable to patients with advanced cancer; in this case, they may be living with tumours and worry about the cancer continuing to progress.…”

“…Some scholars do not differentiate between FCR and FoP 21,22 . However, from the oncological perspective, the two are different 23 . FCR may be applicable to patients with early‐stage cancer, especially those who have undergone surgical resection of the lesion; they may have a sense of fear of the disease before having experienced a relapse.…”