1. Stacey L. Hart1, Marc A. Kowalkowski2, Gilad E. Amiel3, Seth P. Lerner3, David M. Latini2,3
1. Ryerson University, Toronto, ON, Canada; 2. VA HSR&D Center of Excellence, Houston, TX, United States;
3. Urology, Baylor College of Medicine, Houston, TX, United States
• Measures included:
 General (EORTC QLQ-C30 v. 3)
health-related quality of life (HRQOL)
 Disease-specific (EORTC BLS-24)
HRQOL
 Psychological distress (Brief Symptom
Index [BSI-18])
 Impact of Events Scale [IES])
 5-item Fear of Recurrence (FOR)
measure from CaPSURE™ study.
• Based on Lee-Jones’ extension of the
Common Sense Model to FOR, we
hypothesized FOR would be
significantly related to measures of
psychological distress, HRQOL, and
disease-specific symptoms.
• We used correlations and analysis of
variance to examine hypothesized
relationships between FOR and other
variables.
• The Cronbach coefficient alpha of the FOR scale was 0.80, indicating good
internal consistency.
• The FOR scale showed good convergent validity as FOR was significantly
correlated with:
 HRQOL (-0.25 - -0.60; Figure 1)
 Disease-specific symptoms (0.35)
 Future perspective (0.66)
 BSI-18 (0.61)
 IES (0.62)
• The scale also showed good discriminant validity as there were no
significant relationships between FOR and:
 Gender
 Age
 General symptoms
 Relationship status
 Education
 Ethnicity
The CaPSURE™ Fear of Recurrence scale is a valid and reliable measure in
nonmuscle-invasive bladder cancer patients, a group with substantial
psychological burden related to concerns about disease progression and
recurrence. Further validation work is needed to establish responsiveness to
change and validity in ethnically diverse populations.
-0.8
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
0.8
-0.17
-0.30
-0.37
-0.60
-0.25
-0.43
-0.51
0.24
0.20 0.19
0.30
0.35
0.66
0.61 0.62
Correlation
EORTC QLQ C-30 HRQOL
EORTC QLQ C-30 Sx Scales
EORTC BLS-24
Results
Conclusions
Figure 1. Correlation with CaPSURE™ Fear of Recurrence
Introduction
Methods
Age [Mean (SD)] 64.6 (9.5)
N %
Gender
Male 85 72.6%
Female 32 27.4%
Race/Ethnicity
White 110 94.0%
Black or African American 2 1.7%
Other 5 4.3%
Marital Status
Married 87 74.4%
Single, never married 3 2.6%
Separated/Divorced 17 14.5%
Widowed 10 8.5%
Education
High School graduate 18 15.4%
Some college 43 36.8%
Bachelor's degree 32 27.4%
Postgraduate degree 24 20.4%
Tumor Stage*
T0 3 2.6%
Ta 11 9.4%
Tis 11 9.4%
T1 21 20.5%
Did not know/Unknown *68 58.1%
Table 1. Participant Characteristics
Objective
To report initial validation in nonmuscle-invasive bladder cancer (NMIBC)
patients of a Fear of Recurrence instrument previously used with prostate
cancer and leukemia patients.
• Study participants (N=117) were drawn from a large private hospital, a
Veterans Affairs hospital, and from the internet.
• Bladder Cancer is the 5th leading cause of cancer mortalities in the United
States.
• Greater than 70,000 new cases of bladder cancer are diagnosed in the
United States each year, with nonmuscle-invasive disease accounting for
75% of diagnoses.
• Surveillance for NMIBC is lengthy and invasive including:
 Quarterly cystoscopy and cytology for the first two years.
 Biannual examinations for the following two years
 Annual examinations after 5 years.
• Despite the extensive surveillance, bladder cancer recurs most frequently of
any malignancy. As many as 80% of individuals diagnosed with bladder
cancer experience at least one recurrence.
• Fear of recurrence (FOR) has been gaining increased attention in
psychosocial cancer research and clinical care.