Concerns about cancer recurrence in Mexican women breast cancer survivors. Psychometric properties of the CARS scale

Mónica Ramírez-Orozco; Mario Enrique Rojas-Russell; Oscar Galindo-Vázquez; Rebeca Robles-García; Rosario Costas-Muñíz; Juan Enrique Bargallo-Rocha; Abelardo Meneses-García

doi:10.22235/cp.v17i1.2777

Authors

Mónica Ramírez-Orozco Instituto Nacional de Cancerología México https://orcid.org/0000-0001-9616-8200
Mario Enrique Rojas-Russell Universidad Nacional Autónoma de México https://orcid.org/0000-0001-6644-1384
Oscar Galindo-Vázquez Instituto Nacional de Cancerología México https://orcid.org/0000-0001-9395-2921
Rebeca Robles-García Instituto Nacional de Psiquiatría https://orcid.org/0000-0001-5958-7393
Rosario Costas-Muñíz Memorial Sloan-Kettering Cancer Center. Department of Psychiatry & Behavioral Sciences. Immigrant Health & Cancer Disparities https://orcid.org/0000-0003-0942-5657
Juan Enrique Bargallo-Rocha Instituto Nacional de Cancerología México https://orcid.org/0000-0003-2867-0332
Abelardo Meneses-García Instituto Nacional de Cancerología México https://orcid.org/0000-0003-4032-4598

DOI:

https://doi.org/10.22235/cp.v17i1.2777

Keywords:

Survival, Breast Cancer, Fear of recurrence, Mexico, Anxiety

Abstract

Fear of recurrence is one of the main affectations of cancer survivors. In Latin-American exist a lack of evidence on the subject and of valid instruments to measure it. The objective of this study was to determine the psychometric properties of the Concerns About Recurrence Scale in Mexican breast cancer survivors. An instrumental study was carried out with 200 women breast cancer survivors with a mean age of 53 years old and a mean survival of 52.5 months. A confirmatory factor analysis of the original version of the scale identified four factors that explained 77 % of the variance and satisfactory goodness of fit indicators: CFI = .967, TLI = .957, SRMR = .035, RMSEA = .071 as well as high internal consistency α = .945. Significant associations were also identified between general fear subscale, anxiety subscale of the HADS and total HADS score (r = .638 and r = .607; p = .01). The CARS presented adequate validity, reliability and factorial structure. It is recommended for usage in clinical care and research with Mexican breast cancer survivors.

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References

American Cancer Society. (2022). Cancer Treatment & Survivorship Facts & Figures 2022-2024. American Cancer Society. https://www.cancer.org/research/cancer-facts-statistics/survivor-facts-figures.html

Batista-Foguet, J. M., Coenders, G., & Alonso, J. (2004). Análisis factorial confirmatorio. Su utilidad en la validación de cuestionarios relacionados con la salud. Medicina Clínica, 122(Supl.1), 21-27. https://doi.org/10.1157/13057542

Carretero Dios, H. & Pérez Meléndez, C. (2005). Normas para el desarrollo y revisión de estudios instrumentales. International journal of clinical and health psychology, 5(3), 521-551.

De Vries, J., Den Oudsten, B. L., Jacobs, P. M. E. P., & Roukema, J. A. (2014). How breast cancer survivors cope with fear of recurrence: a focus group study. Supportive Care in Cancer, 2(3), 705-712. https://doi.org/10.1007/s00520-013-2025-y

Finney, S. & DiStefano, C. (2006). Non-normal and Categorical data in structural equation modeling. In G. Hancock & R. Mueller (Eds.), Structural equation modeling: a second course (pp. 269-314). Information Age Publishing.

Fiszer, C., Dolbeault, S., Sultan, S., & Brédart, A. (2014). Prevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: a systematic review. Psycho-Oncology, 23(4), 361-374. https://doi.org/10.1002/pon.3432

Galindo Vázquez, O., Benjet, C., Juárez García, F., Rojas Castillo, E., Riveros Rosas, A., Aguilar Ponce, J. L., & Álvarez Avitia, M. Á. (2015). Propiedades psicométricas de la Escala Hospitalaria de Ansiedad y Depresión (HADS) en una población de pacientes oncológicos mexicanos. Salud mental, 38(4), 253-258. https://doi.org/10.17711/SM.0185-3325.2015.035

Hernández Sampieri, R., Fernández Collado, C., & Baptista Lucio, P. (2016). Metodología de la Investigación (6th ed.). McGraw-Hill.

Herrero, J. (2010). El análisis factorial confirmatorio en el estudio de la estructura y estabilidad de los instrumentos de evaluación: un ejemplo con el Cuestionario de Autoestima CA-14. Psychosocial Intervention, 19(3), 289-300. https://doi.org/10.5093/in2010v19n3a9

Instituto Nacional de Cancerología. (2018). Registro de Supervivientes de cáncer en México [Folleto].

Jones, J. M., Olson, K., Catton, P., Catton, C. N., Fleshner, N. E., Krzyzanowska, M. K., McCready, D. R., Wong, R. K. S., Jiang, H., & Howell, D. (2016). Cancer-related fatigue and associated disability in post-treatment cancer survivors. Journal of Cancer Survivorship: Research and Practice, 10(1), 51-61. https://doi.org/10.1007/s11764-015-0450-2

Koller, M., Aaronson, N. K., Blazeby, J., Bottomley, A., Dewolf, L., Fayers, P., Johnson, C., Ramage, J., Scott, N., & West, K. (2007). Translation procedures for standardized quality of life questionnaires: The European Organization for Research and Treatment of Cancer (EORTC) approach. European Journal of Cancer, 43(12), 1810-1820. https://doi.org/10.1016/j.ejca.2007.05.029

Lai, H. L., Hung, C. M., Chen, C. I., Shih, M. L., & Huang, C. Y. (2020). Resilience and coping styles as predictors of health outcomes in breast cancer patients: a structural equation modelling analysis. European Journal of Cancer Care, 29(1), e13161. https://doi.org/10.1111/ecc.13161

Lashbrook, M. P., Valery, P. C., Knott, V., Kirshbaum, M. N., & Bernardes, C. M. (2018). Coping strategies used by breast, prostate, and colorectal cancer survivors: a literature review. Cancer Nursing, 41(5), E23-E39. https://doi.org/10.1097/NCC.0000000000000528

Lengacher, C. A., Reich, R. R., Paterson, C. L., Ramesar, S., Park, J. Y., Alinat, C., Johnson-Mallard, V., Moscoso, M., Budhrani-Shani, P., Miladinovic, B., Jacobsen, P. B., Cox, C. E., Goodman, M., & Kip, K. E. (2016). Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial. Journal of Clinical Oncology, 34(24), 2827-2834. https://doi.org/10.1200/JCO.2015.65.7874

Merckaert, I., Lewis, F., Delevallez, F., Herman, S., Caillier, M., Delvaux, N., Libert, Y., Liénard, A., Nogaret, J.-M., Ogez, D., Scalliet, P., Slachmuylder, J.-L., Van Houtte, P., & Razavi, D. (2017). Improving anxiety regulation in patients with breast cancer at the beginning of the survivorship period: A randomized clinical trial comparing the benefits of single-component and multiple-component group interventions. Psycho-Oncology, 26(8), 1147-1154. https://doi.org/10.1002/pon.4294

Momino, K., Akechi, T., Yamashita, T., Fujita, T., Hayahi, H., Tsunoda, N., Miyashita, M., & Iwata, H. (2014). Psychometric properties of the Japanese version of the Concerns About Recurrence Scale (CARS-J). Japanese Journal of Clinical Oncology, 44(5), 456-462. https://doi.org/10.1093/jjco/hyu032

Mora-Ríos, J., Bautista-Aguilar, N., Natera, G., & Pedersen, D. (2013). Adaptación cultural de instrumentos de medida sobre estigma y enfermedad mental en la Ciudad de México. Salud Mental, 36(1), 9-18. https://doi.org/10.17711/sm.0185-3325.2013.002

Morata-Ramirez, M. Á., Holgado Tello, F. P., Barbero-García, M. I., & Mendez, G. (2015). Análisis factorial confirmatorio. Recomendaciones sobre mínimos cuadrados no ponderados en función del error Tipo I de Ji-Cuadrado y RMSEA. Acción Psicológica, 12(1), 79. https://doi.org/10.5944/ap.12.1.14362

Mutsaers, B., Jones, G., Rutkowski, N., Tomei, C., Séguin Leclair, C., Petricone-Westwood, D., Simard, S., & Lebel, S. (2016). When fear of cancer recurrence becomes a clinical issue: A qualitative analysis of features associated with clinical fear of cancer recurrence. Supportive Care in Cancer, 24(10), 4207-4218. https://doi.org/10.1007/s00520-016-3248-5

National Comprehensive Cancer Network. (2022). NCCN Clinical Practice Guidelines in Oncology, Survivorship. https://www.nccn.org/guidelines/guidelines-detail?category=3&id=1466

Nunnally, J. C. & Bernstein, I. (1995). Teoría psicométrica. McGraw-Hill.

Park, S. Y. & Lim, J. W. (2022). Cognitive behavioral therapy for reducing fear of cancer recurrence (FCR) among breast cancer survivors: A systematic review of the literature. BMC Cancer, 22, 217. https://doi.org/10.1186/s12885-021-08909-y

Ravindran, O. S., Shankar, A., & Murthy, T. (2019). A Comparative Study on Perceived Stress, Coping, Quality of Life, and Hopelessness between Cancer Patients and Survivors. Indian Journal of Palliative Care, 25(3), 414-420. https://doi.org/10.4103/IJPC.IJPC_1_19

Simard, S. & Savard, J. (2015). Screening and comorbidity of clinical levels of fear of cancer recurrence. Journal of Cancer Survivorship: Research and Practice, 9(3), 481-491. https://doi.org/10.1007/s11764-015-0424-4

Simard, S., Thewes, B., Humphris, G., Dixon, M., Hayden, C., Mireskandari, S., & Ozakinci, G. (2013). Fear of cancer recurrence in adult cancer survivors: A systematic review of quantitative studies. Journal of Cancer Survivorship: Research and Practice, 7(3), 300-322. https://doi.org/10.1007/s11764-013-0272-z

Thewes, B., Butow, P., Zachariae, R., Christensen, S., Simard, S., & Gotay, C. (2012). Fear of cancer recurrence: A systematic literature review of self-report measures. Psycho-Oncology, 21(6), 571-587. https://doi.org/10.1002/pon.2070

van den Beuken-van Everdingen, M. H. J., Peters, M. L., de Rijke, J. M., Schouten, H. C., van Kleef, M., & Patijn, J. (2008). Concerns of former breast cancer patients about disease recurrence: A validation and prevalence study. Psycho-Oncology, 17(11), 1137-1145. https://doi.org/10.1002/pon.1340

Vickberg, S. M. J. (2003). The Concerns About Recurrence Scale (CARS): a systematic measure of women’s fears about the possibility of breast cancer recurrence. Annals of Behavioral Medicine, 25(1), 16-24. https://doi.org/10.1207/s15324796abm2501_03