Abstract
The Concerns About Recurrence Scale (CARS) systematically assesses the extent and nature of women’s fears about the possibility of breast cancer recurrence. In this study with 169 breast cancer survivors, scores on the CARS indicate moderate levels of fear about recurrence overall and demonstrate a range in levels of fear. Findings further suggest that women’s fears of recurrence center around the possibility of death, future treatment, and threats to health more than issues related to roles, femininity, sexuality, or body image. Younger women and women who have had chemotherapy demonstrate greater fears. There is little evidence that cancer stage, time since diagnosis, or type of surgery relate to fears. The CARS was found to be internally consistent, and there is preliminary evidence of its validity, although future research is needed. The measure will likely be a useful tool for researchers and clinicians seeking to understand women’s fears about the possibility of breast cancer recurrence.
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References
American Cancer Society:Breast Cancer Facts and Figures. Atlanta, GA: American Cancer Society, 2001.
Glanz K, Lerman C: Psychosocial impact of breast cancer: A critical review.Annals of Behavioral Medicine. 1992,14:204–212.
Omne-Ponten M, Sjoden PO: Psychological adjustment among with breast cancer stages I and II: Six year follow-up of consecutive patients.Journal of Clinical Oncology. 1994,12:1178–1782.
Schover LR, Yetman RJ, Tuason LJ, et al.: Partial mastectomy and breast reconstruction: A comparison of their effect on psychosocial adjustment, body image, and sexuality.Cancer. 1995,75:54–64.
Vickberg SMJ, Bovbjerg DH, DuHamel KN, Currie V, Redd WH: Intrusive thoughts and psychological distress among breast cancer survivors: Global meaning as a possible protective factor.Behavioral Medicine. 2000,25:152–160.
Curran D, van Dongen JP, Aaronson NK, et al.: Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: Results of EORTC trial 10801.European Journal of Cancer. 1998,34:307–314.
Noguchi M, Kitagawa H, Kinoshita K, et al.: Psychologic and cosmetic self-assessments of breast conserving therapy compared with mastectomy and immediate breast reconstruction.Journal of Surgical Oncology. 1993,54:260–266.
Pistrang N, Barker C: Disclosure of concerns in breast cancer.Psycho-Oncology. 1992,1:183–192.
Polinsky ML: Functional status of long-term breast cancer survivors: Demonstrating chronicity.Health & Social Work. 1994,19:165–173.
Sneeuw KCA, Aaronson NK, Yarnold JR, et al: Cosmetic and functional outcomes of breast conserving treatment for early stage breast cancer. 2. Relationship with psychosocial functioning.Radiotherapy and Oncology. 1992,25:160–166.
Vickberg SMJ: Fears about breast cancer recurrence: Interviews with a diverse sample.Cancer Practice. 2001,9:237–243.
Ferrell B, Grant M, Funk B, Otis-Green S, Garcia N: Quality of life in breast cancer survivors: Implications for developing support services.Oncology Nursing Forum. 1998,25:887–895.
Fredette SL: Breast cancer survivors: Concerns and coping.Cancer Nursing. 1995,18:35–46.
Spencer S, Lehman J, Wynings C, et al.: Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients.Health Psychology. 1999,18:159–168.
Kahane D:No Less a Woman: Femininity, Sexuality & Breast Cancer. Alameda, CA: Hunter House, 1995.
Mast ME: Survivors of breast cancer: Illness uncertainty, positive reappraisal, and emotional distress.Oncology Nursing Forum. 1998,25:555–562.
Moyer A, Salovey P: Patient participation in treatment decision making and the psychological consequences of breast cancer surgery.Women’s Health: Research on Gender, Behavior, and Policy. 1998,4:103–116.
Walker BL: Adjustment of husbands and wives to breast cancer.Cancer Practice. 1997,5:92–98.
Kemeny MM, Wellisch DK, Schain WS: Psychosocial outcome in a randomized surgical trial for treatment of primary breast cancer.Cancer. 1988,62:1231–1237.
Lampic C, Wennberg A, Schill J, et al.: Anxiety and cancer-related worry of cancer patients at routine follow-up visits.Acta Oncologica. 1994,33:119–125.
Northouse L: Mastectomy patients and the fear of cancer recurrence.Cancer Nursing. 1981,4:213–220.
Lazarus RS, Folkman S:Stress, Appraisal, and Coping. New York: Springer, 1984.
Fiske ST, Taylor SE:Social Cognition. Reading, MA: Addison-Wesley, 1984.
Kirsch I:How Expectancies Shape Experiences. Washington, DC: American Psychological Association, 1999.
Parle M, Jones B, Maguire P: Maladaptive coping and affective disorders among cancer patients.Psychological Medicine. 1996,26:735–744.
Kurtz ME, Wyatt G, Kurtz JC: Psychological and sexual well-being, philosophical/spiritual views, and health habits of long-term cancer survivors.Health Care for Women International. 1995,16:253–262.
Schover LR: Sexuality and body image in younger women with breast cancer.Journal of the National Cancer Institute Monographs. 1994,16:177–182.
Fife B: The conceptualization of meaning in illness.Social Science Medicine. 1994,38:309–316.
Arathuzik MD: The appraisal of pain and coping in cancer patients.Western Journal of Nursing Research. 1991,13:714–731.
Meyerowitz BE, Chaiken S, Clark LK: Sex roles and culture: Social and personal reactions to breast cancer. In Fine M, Asch A (eds),Women with Disabilities: Essays in Psychology, Culture, and Politics. Philadelphia: Temple University Press, 1988, 72–89.
Horowitz M, Wilner N, Alvarez W: The Impact of Event Scale: A measure of subjective stress.Psychosomatic Medicine. 1979,41:209–218.
Veit CT, Ware JE: The structure of psychological distress and well-being in general populations.Journal of Consulting and Clinical Psychology. 1983,51:730–742.
Bollen KA:Structural Equations with Latent Variables. New York: Wiley, 1989.
Yalom M:A History of the Breast. New York: Knopf, 1997.
Moyer A: Psychosocial outcomes of breast-conserving surgery versus mastectomy: A meta-analytic review.Health Psychology. 1997,16:284–298.
Butler LD, Koopman C, Classen C, Spiegel D: Traumatic stress, life events, and emotional support in women with metastatic breast cancer: Cancer-related stress symptoms associated with past and current stressors.Health Psychology. 1999,18:555–560.
Felton BJ, Revenson TA, Hinrichsen GA: Stress and coping in the explanation of psychological adjustment among chronically ill adults.Social Sciences and Medicine. 1984,18:889–898.
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This research was supported by a National Research Service Award for Individual Pre-Doctoral Fellows from the National Institute of Mental Health (MH11886-02) and a grant from Sex Roles: A Journal of Research. A portion of these data were presented at the annual meeting of the Society for Behavioral Medicine (March 1999).
The study is part of my doctoral dissertation. I thank my advisor, Tracey Revenson, Ph.D., and my committee members, Kay Deaux, Ph.D., Gary Winkel, Ph.D., William Redd, Ph.D., and Vita Rabinowitz, Ph.D. I also thank Dennis Timony for his help in identifying potential participants; Paul Tartter, M.D., Marshall Weiss, M.D., Cheryl Green, M.D., Susan Kaiser, M.D., Ph.D., F.A.C.S., and Lynda Mandell, M.D., for helping to recruit participants; and Andrea Geduld, ACSW, Alysan Goldfarb, M.D., and Juliet Obropta, R.N. for providing feedback on the measure.
The full Concerns About Recurrence Scale can be accessed at the following URL: http://www.suzannevickberg.com
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Vickberg, S.M.J. The concerns about recurrence scale (CARS): A systematic measure of women’s fears about the possibility of breast cancer recurrence. ann. behav. med. 25, 16–24 (2003). https://doi.org/10.1207/S15324796ABM2501_03
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DOI: https://doi.org/10.1207/S15324796ABM2501_03