Author reply: Brief screening of breast cancer survivors with distressing fear of recurrence

Excerpt

Thank you for your interest with regard to our finding that investigates one-item brief screening of breast cancer survivors with distressing fear of recurrence. As Thewes et al. indicate, we totally agree that the area of fear of cancer recurrence (FCR) experienced by cancer patients is rapidly a growing field and there is no consensus about clinical diagnosis of FCR. As we reveal clearly in our letter, we would like to state that our findings are just preliminary ones by retrospectively using available data and we understand the many limitations of the findings such as using the Hospital Anxiety and Depression Scale as an external criterion. Thewes’s excellent review paper helps us understand current status and future perspective of FCR research [1]. In addition, their paper notices us recent data about screening of FCR [2]. Simard’s study investigating the screening performance of the shorter form of the Fear of Cancer Recurrence Inventory (FCRI-SF) for identifying clinical significant level of FCR that was evaluated by clinical interview and they show 88 % sensitivity and 75 % specificity among 60 mixed cancer patients [2]. We think that FCRI-SF consisting nine-item may have better screening capacity while more studies are needed to compare the performance of the different instruments. With regard to the wordings of the Concerns About Recurrence Scale, there are also differences between the anchor point of the two items (e.g., consistency item: 1 = I never worry about it; 6 = I worry about it all the time, frequency item: 1 = I don’t think about it all; 6 = I think about it all the time) and we think this also brings the potential differences between these items. Since appropriate selection of the screening instrument can depend on both the purpose of screening and situations, we would like to entrust it to each reader, researchers and/or medical staff. In the future, evaluation of the stratum-specific likelihood ratios (SSLRs) of a screening instrument may be recommended because anchor points of most instruments have continuous variables and SSLRs is now being increasingly recognized as a more convenient and generalizable method of interpreting diagnostic information regarding performance than an optimal cutoff and sensitivity and specificity approach [3]. Finally thanks again for you interest to our letter and we also hope their research group provide us useful findings for improving care for the cancer patients. …