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Systematic Review of Fear of Cancer Recurrence Patient-Reported Outcome Measures: Evaluating Methodological Quality
Christine Maheu1, Wing Lam Tock2, Peter Fisher3
1Ingram School of Nursing, McGill University, Montréal, QC H3A 2M7, Canada.
Healthcare (Basel, Switzerland)
|September 13, 2025
Summary
This study evaluated patient-reported outcome measures for fear of cancer recurrence (FCR), finding many reliable tools for survivors. The FCR-1, FCRI-SF, and FoP-Q-SF are recommended for clinical use.
Area of Science:
- Psychometric evaluation of health-related instruments.
- Cancer survivorship and psycho-oncology research.
- Development and validation of patient-reported outcome measures (PROMs).
Background:
- Fear of cancer recurrence (FCR) significantly impacts cancer survivors' psychological well-being and quality of life.
- A wide range of PROMs exist to assess FCR, but consensus on their validity and reliability is lacking.
- This study addresses the need for a systematic psychometric evaluation of contemporary FCR PROMs.
Purpose of the Study:
- To conduct a comprehensive psychometric evaluation of FCR PROMs developed or validated between 2011 and 2023.
- To apply the full COSMIN methodology for rigorous appraisal of measurement properties.
- To provide evidence-based guidance for selecting appropriate FCR PROMs in clinical and research settings.
Main Methods:
- Systematic review following COSMIN 10-step procedure and PRISMA 2020 guidelines.
- Searched six databases (Jan 2011–Dec 2023) for studies evaluating self-reported, Likert-scale FCR PROMs in adult cancer survivors.
- Appraised eight psychometric properties using COSMIN checklists, criteria for good measurement properties, and modified GRADE for evidence quality.
Main Results:
- 28 out of 34 evaluated PROMs achieved COSMIN Category A status, indicating sufficient psychometric quality.
- 15 of 19 cross-culturally validated FCRI and FoP-Q instruments received Category A, showing strong performance.
- The FCR-1 single-item PROM demonstrated responsiveness; FCR-1, FCRI-SF, FoP-Q-SF, FCR-7, and CWS are recommended for clinical use.
Conclusions:
- Significant progress has been made in developing valid, reliable, and culturally adaptable FCR PROMs.
- The FCRI, FoP-Q-SF, FCR7, CWS, and FCR-1 are strongly supported for clinical screening and longitudinal assessment.
- This review offers clear, evidence-based guidance for selecting FCR instruments in cancer survivorship care and research.
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