Purpose: Fear of cancer recurrence (FCR) is prevalent amongst survivors, and breast cancer survivors are particularly vulnerable. Currently, there are few well-validated brief measures of FCR and none specific to breast cancer. This manuscript describes the development and initial validation of a new measure of FCR for breast cancer survivors, the Concerns about Recurrence Questionnaire (CARQ), and reports its initial validation in an Australian and Danish population-based sample of breast cancer survivors.
Methods: CTT analyses explored scale reliability and validity; Rasch analyses explored model fit statistics, item bias (DIF) and local dependency. Three-item, four-item and five-item versions were considered.
Results: Two hundred eighteen Australian women aged 28-45 years diagnosed with early-stage breast cancer (stages 0-2) and 2001 Danish women diagnosed with breast cancer (stages 1-3) aged 26-70 completed the CARQ. Based on the results of both CTT and IRT analyses, the four-item English version of the scale performed best. Although the CTT analyses suggested that the CARQ-4 was reliable and valid in both samples, Rasch analyses identified item bias relative to age, and local dependence which may be remedied by further scale development.
Conclusions: The CARQ-4 English version is currently one of the most rigorously tested brief scales of FCR available.
Implications for cancer survivors: The availability of more valid and reliable brief measures of FCR will help to promote research and screening of FCR amongst cancer survivors.