Validity of the German Version of the FCR-1r Questionnaire in Patients with Urologic Cancer.

Abstract

Introduction: Fear of cancer recurrence (FCR) is a prevalent and distressing issue for a significant proportion of cancer patients across various disciplines, yet it remains one of the most frequently unaddressed psychosocial needs. A key barrier to identifying affected individuals is the lack of brief screening tools suitable for clinical settings. The objective of this research is to validate the one-item FCR screening tool (revised Fear of Cancer Recurrence-1 [FCR-1r]) in a German cohort of urologic cancer patients. Validating such an ultra-brief measure may help address this clinically relevant gap and serve as a viable, clinically applicable alternative to lengthy questionnaires.

Methods: Statistical analyses were conducted using R software. Criterion validity was assessed against the Concerns About Recurrence Questionnaire-4 (CARQ-4). Convergent validity was tested against the Fear of Progression Questionnaire - Short Form (FoP-Q-SF) and Generalised Anxiety Disorder-7 (GAD-7). Discriminant validity was tested against the Health Literacy Survey-European-Questionnaire 16 (HLS-EU-Q16). Validity was assessed using chi-square tests with phi coefficients, accuracy measures, negative and positive predictive values, sensitivity, specificity and odds ratios.

Results: The final analysis sample consisted of 236 participants with complete data on all study measures. The FCR-1r demonstrated excellent criterion validity with respect to the CARQ-4 (χ2[1] = 101.97, p < 0.001, φ = 0.66), with an overall accuracy of 84% (95% CI: 79-89%). Sensitivity was 84%, and specificity was 85%. The analysis of convergent validity revealed a moderate association with both the FoP-Q-SF (χ2[1] = 20.25, p < 0.001, φ = 0.29; accuracy 62% [95% CI: 56-68%]) and the GAD-7 (χ2[1] = 11.82, p < 0.001, φ = 0.22; accuracy 64% [95% CI: 58-70%]). The analysis of discriminant validity showed no significant association between the FCR-1r and health literacy (HLS-EU-Q16): χ2(1) = 3.44, p = 0.064, φ = 0.12.

Conclusion: The German version of the FCR-1r demonstrates good psychometric properties, confirming its validity as a tool for assessing FCR in clinical practice.