Assessing and managing patient fear of cancer recurrence

Clinically significant FCR

Fear of cancer recurrence has been defined as “fear, worry or concern relating to the possibility that cancer will come back or progress.”³ Given that recurrence is a very real possibility, FCR is a normative reaction affecting most cancer survivors to some degree.² The severity of FCR can be conceptualized on a continuum, from transient fears (often occurring in conjunction with upcoming medical tests or results, anniversary of diagnosis, etc) to more substantial levels of fear that are difficult to control and might interfere with daily functioning and overall well-being.³ A recent study of experts in the field of FCR identified the following key features of clinically significant FCR: high levels of preoccupation or worry, worry that is persistent, and hypervigilance or hypersensitivity to bodily symptoms, where any of these features last for at least 3 months.⁴ Other important aspects include functional impairment and maladaptive coping strategies such as excessively seeking reassurance from medical professionals, excessive body checking, or avoiding medical appointments.⁵ Additionally, clinically significant FCR is linked to more health care use²; however, a number of empirically supported interventions have been developed to treat FCR.⁶

Screening and assessing for FCR

One of the most commonly used measures of FCR is the Fear of Cancer Recurrence Inventory (FCRI).⁷ The short form of this measure (FCRI-SF), consisting of 9 items, has been used as a tool to screen for clinical levels of FCR and is available for download at CFPlus.^* Each item is rated on a scale from 0 (not at all or never) to 4 (a great deal or several), where higher scores indicate greater FCR severity, with a maximum score of 36.⁷ When calculating the score, item 5 is reverse coded. The recommended cutoff score for clinical levels of FCR is 22 or greater.⁸ However, a score of 16 or greater indicates high FCR and requires further assessment and discussion.⁹ The differences in cutoff scores in the literature are largely attributable to differences in methodology. These include the limited number of studies, small sample sizes, and, until recently,⁴ a lack of agreement on what constitutes clinical FCR. Research in this area is ongoing.⁸ Further to the FCRI, a conversation assessing the persistence of worries, preoccupations, and hypervigilance or hypersensitivity to bodily symptoms related to FCR is warranted (Table 1).^4,10 Referrals can be made for psychosocial support contingent on the extent that the patient’s FCR is reported as problematic for the patient or is interfering with the patient’s ability to engage in daily life.

Managing FCR