Assessing multidimensional worry in cancer survivors

Abstract

Anxiety in cancer survivors has been characterized in numerous ways. One way is posttraumatic stress disorder (PTSD) symptoms [1]. This approach usefully captures intrusive thoughts, avoidance, and hyperarousal – focusing on cancer as a past trauma creating current symptoms. Another characterization of anxiety focuses on the fear of recurrence (FOR) [2]. FOR appears common in survivors, potentially lasting for many years post-treatment. Still, others have characterized anxiety with multidimensional scales, such as for prostate cancer [3] and breast cancer [4]. Worry differs from these in that it is future oriented; therefore, it is unlike PTSD symptoms, which are past-focused. Worry shares with FOR that both are cognitive behaviors aimed at reducing anxious arousal. FOR is a contextually specific and important worry, but survivors may also worry about other issues. At least two worry scales have been developed for women with breast cancer. The 8-item Cancer Worries Scale includes worries about recurrence, future surgery, and family [5], yielding a one factor solution. The 15-item Brief Cancer-Related Worry Inventory includes worries about cancer getting worse, effects of current treatment, work, and economics [6], yielding a three factor solution for (i) future prospects; (ii) physical and somatic problems; and (iii) social and interpersonal problems. Building on important work with breast cancer survivors, we aimed to develop a multidimensional measure of worry, which (i) creates items based on the words of survivors; (ii) describes a range of concerns; and (iii) is brief, and therefore, practical in clinical and research applications.