Fear of Cancer Recurrence Inventory Validation in Hindi: Phase I

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Pushpak. Kumar. Jena, Amit Agarwal This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7149326/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: This research investigated the acceptance level of the fear of cancer recurrence inventory, multidimensional measure in the Hindi language. Methods: First, the forward–backward translation of Hindi-speaking cancer patients was tested; second, cross-cultural equivalence was established with a sample of 30 bilingual (English and Hindi speaking) cancer patients; and finally, the psychometric properties of the questionnaire were measured in a sample of 100 heterogeneous Hindi-speaking patients. Cronbach’s alpha was used to establish internal consistency. Results: The Hindi translation of the FCRI was well accepted, and item bias was not observed when it was administered to bilingual participants. The Cronbach’s alpha reliability of the scale was 0.93 (95% CI: 0.8–0.93), Spearman’s Brown Coefficient was 0.88 and KMO = 0.84 was significant at .05 level, suggesting significant construct validity. Conclusion: The Hindi version of the FCRI is a well-accepted and reliable measure of fear of cancer recurrence in heterogeneous cancer patients for larger phase-II study. Cancer Fear of Cancer Recurrence Bilingual FCRI Background Advancements in cancer detection and treatment have resulted in more patients surviving and living with the disease. In India, it is estimated that 641 per 100,000 middle-aged individuals are cancer survivors ( 1 ). As a result, there is an increasing focus on psychosocial factors and quality of life among cancer survivors. Notably, the fear of recurrence remains prevalent among both current patients and survivors, often persisting even after successful completion of treatment. According to Vickberg (2003), fear of cancer recurrence is the worry or fear that the cancer will return to or progress in the same organ or in any other part of the body, 22–99% of cancer survivors report fear of cancer recurrence ( 2 – 4 ) the most distressful issue observed among cancer patients ( 5 ). Most reports focused on lung, prostrate, breasts, and colorectal cancer sites ( 6 ). Age, sex, and education level are associated with fear of cancer recurrence ( 7 – 9 ) along with chemotherapy ( 10 , 11 ). Various brief and few extensive tools have been developed to assess fear of cancer recurrence, and a few have been translated and validated in the Hindi language. Specifically, patient and family concerns about recurrence-Fear of Recurrence Inventory, ( 12 ) triggers -Worry of Cancer Recurrence Scale, ( 13 ) beliefs, and anxiety regarding recurrence-Fear of Cancer Recurrence Scale ( 14 ). Some measures lack validity-Fear of Recurrence Questionnaire ( 15 ), lack the ability to measure the frequency and duration of fear of cancer recurrence-Fear of Progression-Questionnaire, ( 16 ) many have been developed for use in breast cancer patients- Concerns About Recurrence Scale, ( 4 ). The developed measures neglected all the relevant dimensions and the Fear of Cancer Recurrence Inventory ( 17 ) is the only inventory that measures intrusive thought, and impaired functioning, and is heterogeneous in terms of age, sex, stage, and type of cancer. The Fear of Cancer Recurrence Inventory was shortlisted because it assesses patients’ fear of cancer recurrence and is a comprehensive tool that provides information on various dimensions including triggers, reassurance, impaired functioning, and intrusive thoughts. Materials & Methods Procedure & Participants To validate the Fear of Cancer Recurrence Inventory (FCRI by Simard & Savard in the Hindi language via the English version of the FCRI of Lebel et al. (2016), the acceptance level in Hindi-speaking cancer patients was studied, and aspects of the psychometric properties of the FCRI were selected. Standard procedures were adapted, and an attempt was made to translate and assess the validity of the FCRI-Hindi (FCRI-H) version via the following steps: a) forward-backward translation, b) pilot testing of the FCRI-H, c) establishing cross-cultural equivalence and d) measuring selected aspects of psychometric properties. The study sample was collected via purposive sampling from a private hospital and informed consent was obtained from all the participants involved in the study. For pilot testing thirty patients were recruited followed by a sample of 100 patients diagnosed with cancer (heterogeneous) who were recruited from the OPD, IPD and daycare departments of the Department of Oncology. Patients were recruited if they were aged between 18 years and 85 years, were both sexes, were diagnosed with cancer and were aware of their illness irrespective of recurrence and metastasis. Patients with the ability to read, speak and understand English/ Hindi or bilingualism were included. Patients who had any significant neurological illness and the presence of any physical illness or psychiatric comorbidity at present were excluded as this might have contributed to the aim of the study. Semi structured interviews were conducted with the focus on socio-demographic details, which were subsequently corroborated from case files, and any discrepancies led to the exclusion of those sample data. To measure bilingual levels, patients were asked to rate themselves on a 0–10 Likert rating scale ranging from ‘not at all’ (0) to ‘completely bilingual’ ( 10 ). Patients were eligible when they rated themselves having a score of 5 or more on the level of bilingualism. Measures Fear of Cancer Recurrence Inventory (FCRI) : The FCRI is a 42-item scale that evaluates seven aspects associated with fear of cancer recurrence in the past month: potential stimuli (triggers), the presence and severity of intrusive thoughts, emotional disturbance, and the impact of fear of cancer recurrence on important areas including functioning capacity; insight levels including self-criticism; coping strategies; and reassurance seeking. Ratings were performed on a Likert scale ranging from not at all (0) to all the time ( 4 ). Scores can be obtained separately for the total scale and each subscale ( 16 ). Reverse scoring was performed for item 13: “I believe that cancer is cured, and cancer will not come back”. A higher score indicates a greater level of fear of cancer recurrence. A score of 13 is the cutoff score. The original French version has internal consistency of .75-0.91 and test-retest reliability ranging from .58-0.83 across subscales. It has a convergent validity of .69 to .77 across the Illness Worry Scale (r = .68), the Fear of Cancer Recurrence Questionnaire (r = .71) and the Concerns About Recurrence Scale (r = .77). Concurrent validity ranges from (r = .43 to .77) and divergent validity ranges from (r = .20 to .36). The English version has Cronbach’s alpha of .71-0.94 and test-retest reliability of r = 0.88–0.94 across the subscales. To reduce the chances of response bias, the trial-making test (TMT) ( 18 ), part A was adapted as a distraction technique and presented between both the versions of the FCRI, and time was not calculated. Translation Permission for translation into Hindi was led by the Simard & Savard. Standardized forward–backward. procedure was adapted. Independent Hindi translators (n = 3) were recruited for forward translations. To evaluate the semantics of the translated version the pooled responses were submitted to three mental health experts fluent in Hindi and English. The experts suggested modifications to use word cancer in Hindi or to use its Hindi term. The translators and mental health professionals were consulted before a consensus was reached and the Hindi term for cancer was retained. Three English translators fluent in Hindi were blinded to the original version for backward translation. Discrepancies related to specific wording and its meaning were identified in relation to the items. Finally, minor modifications were completed, and a consensus was reached for the Hindi version after discussion. The randomization of questions (between and within) was performed by computer-generated random numbers in Microsoft Excel for the Hindi version to reduce response bias and to improve overall data quality. Pilot testing Thirty heterogeneous cancer patients from the Department of Oncology of the hospital were pilot tested on the Hindi version. Before recruiting a brief interview was held with individuals suffering from cancer to determine if they met the inclusion and exclusion criteria. Individuals were briefed about the study and written informed consent was obtained, in which the nature of the illness, rationale for the current pilot study, and confidentiality issues including voluntary control were explained to the individual, and queries were clarified. The initial interview took approximately 10 minutes. Once the criterion was met the semi structured interview focused on the participants’ a) sociodemographic details, b) awareness of their illness, c) onset and duration of illness. Semi structured interviews helped the researcher recruit the participants to study and understand their current psychological state (see supplementary file 1), which helped in planning appropriate referrals. Following the completion of the Hindi questionnaire, researchers evaluated the clarity of the following a) instructions, b) items, and c) answer formats. The participants rated their answers on the following basis: i) difficulty in understanding, ii) difficulty in answering, iii) the presence of confusing statements/items/words, iv) finding any item upsetting/offensive, and v) feeling that there was any need to rephrase the statement/item; if yes, then an alternative formulation was invited and recorded for items or words for which they were unclear. This process took approximately 15–20 minutes. No further changes were made, as the participants did not claim problems with any of the items or instructions (see supplementary file 1). Cross-Cultural Validation Vallerand( 19 ) has recommended adapting bilingual participants to assess cultural equivalence before establishing the psychometric properties of the translated version in one of his six steps for validation. Haccoun ( 20 ) suggested administering both versions of the questionnaire to bilingual participants in randomized order to ensure semantic equivalence. Considering the recommendations and to ensure counterbalanced approach, 100 participants who agreed to participate and met the inclusion-exclusion criteria were randomly assigned in phase- I to complete both versions of the FCRI (Hindi and English) either of which was administered first followed by a trial-making test in between as a distraction to reduce the likelihood of response bias and mechanical answers. Statistical Analysis The data was verified and examined using standard procedures. SPSS version 25.0 software was used for analysis. The psychometric properties of the FCRI-H were established via various steps. Descriptive statistics were performed to determine the means and medians. Correlation- coefficients between subcomponents were calculated. Three-way interaction was assessed to understand the relationships among items, language ( 16 ) and randomization. As the data are exceedingly small (due to a lack of resources and time) for confirmatory factor analysis (CFA), Bartlett’s test of sphericity was performed before calculating the CFA. CFA was used to assess the construct validity and replicate the original factor structure of the English version of the FCRI ( 17 ). The coefficient alpha was established for the subscales and total scale of the FCRI and internal consistency, and the item-total correlation coefficient was also calculated in this phase. Ethical consideration Written informed consent was obtained from the participants. The participants had the right to discontinue their involvement as per their decisions. For significant information elicited during the assessment, the appropriate intervention was planned or was referred to team psychologist or oncologist. Results This section provides description of the participants (n = 100) assigned to test validation of the FCRI. It also includes descriptions of pilot tests performed on a sample of 30 participants undergoing cancer treatment. Pilot testing Forty-four participants were approached by the researcher, out of whom thirty heterogeneous cancer patients agreed to participate in the pilot-study, the majority of whom were females (56.7%), graduates (53.3%), married (76.6%), employed (36.7%), Hindu by religion (80%), of middle socioeconomic status (63.3%), lived in joint families (53.3%) and hailed from urban areas (96.7%) with a mean age of 55 years (range: 26–74), a mean age of onset of 53.3 years (range: 25–73), a mean duration of illness of 11.8 months (range: 1–48). The majority of patients with a breast cancer diagnosis (30%) had not undergone surgery (60%), and 70% did not experience recurrent episode. All the patients (100%) were receiving chemotherapy. On Facets of Interview , most participants reported that the questionnaire was easy to answer (70%), easy-to-understand (76.7%), not confusing (93.3%), upsetting/offensive (80%), and did not need to rephrase (100%) (see supplementary file 1). Cross-cultural validation In total, one hundred and twenty-eight patients were approached by the researcher, of whom twenty-eight patients refused to participate in the study for various reasons (not interested, health concerns or worries and being uncomfortable in sharing or talking about illness), leaving a sample of 100 patients. Patients were assessed via both the Hindi and English versions of the questionnaire. The majority of patients were females (66%), married (86%), Hindu by religion (89%), graduated (62%), homemakers (31%), had middle socioeconomic status (71%), hailing from an urban background (99%) and lived in a nuclear family (56%). The mean age of the participants was 56.31 ± 12.85 years, the age of onset was 54.04 ± 12.84, the duration of illness was 4.14 ± 1.58, and the mean stage was 2.72 ± 0.79 and the number of chemotherapy cycles was 7.66 ± 7.17 (see supplementary file 2). Psychometric properties A lack of relationship between the two versions was observed i.e., three-way interaction (Items X Language X Randomization) was not significant (F = 2.13, p < .63), no significance (Item X Randomization) was present (F = 0.78, p < .64) and no significance (Item X Language) was observed (F = 0.92, p < .86) indicating that the questionnaire items were not influenced by language or by the randomization of the items or two versions (Hindi and English). Table 1 presents the inter-correlations between the total score and the factors of the FCRI and reliability indices. Like the English version of the FCRI (Lebel et al., 2016), the FCRI-Hindi total and subscale scores range from 0.22–0.88 and 0.29–0.73 of item-total correlations, respectively, indicating that the factors measured by the FCRI are related to the overall score. A higher correlation indicates significant contributors to the overall assessment of FCR. The Cronbach’s alpha coefficients range from 0.63 to 0.83 and 0.96 for the subscales and total scale of the FCRI, respectively, and are significant at the 0.01 level. The items within each subscale and the total scale relaibly measure the same underlying concept reliably. Table 1 Interitem correlations between factors and Cronbach’s alpha. FCRI Factors F1 F2 F3 F4 F5 F6 F7 Total Corrected item-total correlations Cronbach’s alpha F1-Triggers 1.0 .73* .64* .54* .65* .57* .24* .81 .59-.81 .81 F2-Severity 1.0 .73* .56* .70* .55* .30* .83* .54-.80 .83 F3-Psychological Distress 1.0 .56* .76* .41* .34* .74* .47-.68 .74 F4-Coping Strategies 1.0 .54* .30* .39* .67* .22-.52 .67 F5-Functioning Impairments 1.0 .41* .30* .70* .43-.52 .70 F6-Insight 1.0 .29* .79* .49-.60 .79 F7-Reassurance 1.0 .44* .59-.84 .63 Total score 1.0 .22-.80 .96 *p < 0.01 (Table adapted from Simard and Savard, 2009). To ensure that CFA can be conducted due to small sample size, the factorability of 42 items and 7 subscales was examined. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was .84, above the recommended value of .60. Bartlett’s test of sphericity is a test of at least one significant correlation between 2 of the items studied and is significant (χ2 (351) = 1086.000, p < .000) thus, the correlation matrix is sufficiently different from an identity matrix and correlations between variables are zero. The data were suitable for factor analysis or principal component analysis (PCA). Using total variance explained, seven original factors can be reduced to 3 underlying components, explaining 51% of the variance in the data. None of the subscales or items were removed because the minimum criterion of having a primary factor loading (0.04 or above) was met. The solutions for all the components were examined via orthogonal rotation. The factor loadings across the items of various subscales can be seen in Table 2 . Medium to high corelations were observed across 42 items of the questionnaire, which were found to be loaded on three factors. Table 2 Extracted components and factor loadings based on principal component analysis using orthogonal rotation. ITEMS Factor Loading 1 2 3 Triggers 1.Television shows or newspaper articles about cancer or illness .45 2. An appointment with doctor .72 3. Medical examinations .73 4. Conversation about cancer in general .68 5. Seeing or hearing someone who is ill .53 6. Going to funeral or reading obituary section .64 7. When I feel unwell physically or when I am sick .84 8. Generally, I avoid situations or things that makes me about FCR .88 Severity .76 9. I am worried or anxious about the possibility of cancer recurrence 10. I am afraid of cancer recurrence .64 11. I believe it is normal to be worried or anxious about the possibility of cancer recurrence .77 12. When I think about the possibility of cancer recurrence, this triggers other unpleasant thoughts or images (such as death, suffering, the consequences for my family) .66 13. I believe that I am cured and that the cancer will not come back .92 14. In your opinion, are you at risk of having a cancer recurrence? .71 15. How often do you think about the possibility of cancer recurrence? .78 16. How much time per day do you spend thinking about the possibility of cancer recurrence? .79 17. How long have you been thinking about the possibility of cancer recurrence? .56 Psychological Distress (When I think about cancer, I feel) .85 18. Worry, fear or anxiety 19. Sadness, discouragement or disappointment .86 20. Frustration, anger or outrage .87 21. Helplessness or resignation .86 Fear (My thoughts or fears about the possibility of cancer recurrence disrupt) .82 22. My social or leisure activities (e.g. outings, sports, travel) 23. My work or everyday activities .84 24. My relationships with my partner, my family, or those close to me .96 25. My ability to make future plans or set life goals .82 26. My state of mind or my mood .83 27. My quality of life in general .86 Insight 28. I feel that I worry excessively about the possibility of cancer recurrence .89 29. Other people think that I worry excessively about the possibility of cancer recurrence .83 30. I think that I worry more about the possibility of cancer recurrence than other people who have been diagnosed with cancer .75 Reassurance .76 31. I call my doctor or other health professional 32. I go to the hospital or clinic for an examination .86 33. I examine myself to see if I have any physical signs of cancer .79 Coping Strategies .74 34. I try to distract myself 35. I try not to think about it, to get the idea out of my mind .85 36. I pray, meditate or do relaxation .63 37. I try to convince myself that everything will be fine or I think positively .79 38. I talk to someone about it .87 39. I try to understand what is happening and deal with it .76 40. I try to find a solution .74 41. I try to replace this thought with a more pleasant one .88 42. I tell myself “stop it” .84 (FCRI Questionnaire adapted from Simard & Savard, 2009). Table 3 Rotated component matrix across subscales. The factor loadings across the subscales are presented in Table 3 . Moderate to high correlations between three subscales (severity, psychological distress, and functioning impairments) and the psychological level (component 1) exist, moderate correlations between three subscales (trigger, insight, and coping strategies) and the insight level (component 2) exist, and high correlations between subscale reassurance and steps to address psychological distress (component 3) exist. Thus, different items on the FCRI are grouped into three main components, each measuring a different aspect of fear of cancer recurrence. Discussion Fear of cancer recurrence (FCR) has been commonly reported in cancer patients irrespective of demographic details and is frequently observed as one of the greatest causes of psychological distress in cancer patients, and survivors. Few studies have been conducted on FCR and a very few standardized and validated tools are available to assess the dimensionalities of FCR. This can be explained by the lack of validated tool in the Hindi language. It becomes more important as 43.63% of Indians converse in Hindi and claim it to be the first language. The findings suggest that the FCRI translation was readily acceptable for Hindi-speaking cancer patients. The results were cross-culturally equivalent to those of the English version, and the replication of the multidimensional structure was observed in the study. Confirmatory factor analysis results revealed the presence of seven subscales on three components, as observed in the English version. However, the results suggest that a reduction in factors and a few items could take place. Future studies can examine the reduction in items or subscales, and a shorter version could be established. The psychometric properties of the FCRI Hindi version are similar to those of the English version. Strong correlations among subscales were observed, replicating the original results. The total scores of the FCRI and seven subscales had moderate reliability coefficients above 0.65. Except for the reassurance subscale, a substantial difference was observed between the FCRI Hindi (r = 0.44) and English (r = 0.70) versions, indicating that the Indian population might have different reassurance strategies. Diverse socioeconomic backgrounds and support (education, family structure) can influence how participants perceive and cope with FCR. Diverse cultural beliefs about illness, health and recovery can directly influence participants’ experiences as Indian traditional practices and beliefs about cancer differ from those of Western cultures. This study has several limitations. First, individuals with early stage cancer might not be adequately reflected because they were diagnosed with early stages of cancer. Second, a cut-off score could not be establish for the FCRI-H to identify clinically significant FCR, as it would provide researchers and physicians with greater insight into clinical diagnosis. Third, India is diverse in nature with varied cultures and beliefs, and psychometric properties were assessed mainly using only one small sample of a heterogeneous group of cancer patients, limiting the generalizability of the findings to other groups. Other psychometric properties were not assessed during this phase, and it would be advisable to assess the remaining psychometric properties in phase-II. Finally, the small sample size of CFA can lead to inaccurate estimates of factor loadings and possibly high, variance which may not be a true representative of a larger population. Overall, this study revealed that the Hindi FCRI has acceptable psychometric properties. These findings support the use of this instrument among Hindi-speaking cancer patients. Future studies can focus on replicating the original and English versions of the factorial structure via a larger sample. Researchers can establish the psychometric properties of the FCRI across cancer sites and stages. The sensitivity of the FCRI to change can be studied in further clinical studies. The Hindi version of the FCRI can be correlated with other quality-of-life tools available in the Hindi language to assess cultural adpatibility. The FCRI can be a promising tool for assessing FCR among Hindi-speaking cancer patients. Abbreviations FCR Fear of Cancer Recurrence FCRI Fear of Cancer Recurrence Inventory FCRI-H Fear of Cancer Recurrence Inventory-Hindi TMT Trail Making Test OPD Out-Patient Department IPD Inpatient Department CFA Confirmatory Factor Analysis KMO Kaiser-Meyer-Olkin PCA Principal Component Analysis Declarations Consent to participate Ethical approval was obtained from the ethics committee of the Dr BLK-Max Hospital, Delhi according to Indian Council of Medical Research on Human Subjects. Informed consent was obtained from all the participants in the study. Consent for publication Not applicable Competing Interests The authors declare that they have no competing interests. Conflict of interest The authors have no conflict of interest to declare. Funding This research received no external funding. Author Contribution All the authors have made substantial contributions to the study conception and design, acquisition of data, drafting/revising the manuscript critically for important intellectual content, and given final approval of the version to be published. KY made substantial contributions to the data collection, and analysis/interpretation. The first draft of the manuscript was written by KY and SPKJ, AA, commented on the previous versions of manuscript and given final approval of the version to be published. All authors have participated sufficiently in the work to take public responsibility for appropriate portions of the content and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy/integrity of any part of the work are appropriately investigated and resolved. Acknowledgement We extend our sincere appreciation to Dr. Simard and Dr. Savard for granting permission to translate the tool into Hindi. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7149326","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":509752890,"identity":"7a7db336-94dd-437d-90bd-efd96455c65a","order_by":0,"name":"Kamna Yadav","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYBACCTjrAAPjAwgvAYyI0sJsQLIWNigHn3ogkGw/nfbgB8Nheb7jZ8wqLH4dZuBnzzFgeLgDtxZpntzthj0Mhw1nnskxuyHZd5hBsueNAUPiGdxa5Bhyt0nwMBxm3HAgLe2GZM9hBoMbQFsS2/Bo4X+7TfIPw2H7DeefpRWAtNgT0iItkbtNGmhL4oYbyccYJH4AbZEgoEVyxttt0jIG6ckzbzw+LCHZkM4jceZZwQF8WiTO526TfFNhbdt3PrHxs8Qfazn+9uSND3/i0QIBBs1gilmyjYEHxDhASAMQ1IFJxg9/iFA7CkbBKBgFIw4AAO8rVTGfXG8nAAAAAElFTkSuQmCC","orcid":"","institution":"O. P. Jindal Global University","correspondingAuthor":true,"prefix":"","firstName":"Kamna","middleName":"","lastName":"Yadav","suffix":""},{"id":509752891,"identity":"2e5c29c0-c934-49b5-a431-08c9a95409b4","order_by":1,"name":"Sampat. Pushpak. Kumar. Jena","email":"","orcid":"","institution":"University of Delhi","correspondingAuthor":false,"prefix":"","firstName":"Sampat.","middleName":"Pushpak. Kumar.","lastName":"Jena","suffix":""},{"id":509752892,"identity":"db2b0662-66dc-4055-a1d7-0b30a5f46a95","order_by":2,"name":"Amit Agarwal","email":"","orcid":"","institution":"Fortis Hospital","correspondingAuthor":false,"prefix":"","firstName":"Amit","middleName":"","lastName":"Agarwal","suffix":""}],"badges":[],"createdAt":"2025-07-17 13:08:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7149326/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7149326/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108926525,"identity":"aad1f01d-4be4-4260-873e-ce506b10690e","added_by":"auto","created_at":"2026-05-10 22:54:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":404577,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7149326/v1/8ce3bb8f-b088-4546-920b-7cbcf297db9b.pdf"},{"id":90674551,"identity":"d2c22562-b0c5-47e3-a479-1f5a4131fbfb","added_by":"auto","created_at":"2025-09-05 14:17:17","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":21296,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7149326/v1/656a2594c386f399aa0be9bf.docx"},{"id":90674276,"identity":"03d49422-898c-46e9-9ad4-ffb2941627fb","added_by":"auto","created_at":"2025-09-05 14:09:17","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":19837,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7149326/v1/01a80e83e97bc8b05e8be134.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Fear of Cancer Recurrence Inventory Validation in Hindi: Phase I","fulltext":[{"header":"Background","content":"\u003cp\u003eAdvancements in cancer detection and treatment have resulted in more patients surviving and living with the disease. In India, it is estimated that 641 per 100,000 middle-aged individuals are cancer survivors (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). As a result, there is an increasing focus on psychosocial factors and quality of life among cancer survivors. Notably, the fear of recurrence remains prevalent among both current patients and survivors, often persisting even after successful completion of treatment.\u003c/p\u003e\u003cp\u003eAccording to Vickberg (2003), fear of cancer recurrence is the worry or fear that the cancer will return to or progress in the same organ or in any other part of the body, 22–99% of cancer survivors report fear of cancer recurrence (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) the most distressful issue observed among cancer patients (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Most reports focused on lung, prostrate, breasts, and colorectal cancer sites (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Age, sex, and education level are associated with fear of cancer recurrence (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e–\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) along with chemotherapy (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eVarious brief and few extensive tools have been developed to assess fear of cancer recurrence, and a few have been translated and validated in the Hindi language. Specifically, patient and family concerns about recurrence-Fear of Recurrence Inventory, (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) triggers -Worry of Cancer Recurrence Scale, (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) beliefs, and anxiety regarding recurrence-Fear of Cancer Recurrence Scale (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Some measures lack validity-Fear of Recurrence Questionnaire (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), lack the ability to measure the frequency and duration of fear of cancer recurrence-Fear of Progression-Questionnaire, (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) many have been developed for use in breast cancer patients- Concerns About Recurrence Scale, (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The developed measures neglected all the relevant dimensions and the Fear of Cancer Recurrence Inventory (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) is the only inventory that measures intrusive thought, and impaired functioning, and is heterogeneous in terms of age, sex, stage, and type of cancer. The Fear of Cancer Recurrence Inventory was shortlisted because it assesses patients’ fear of cancer recurrence and is a comprehensive tool that provides information on various dimensions including triggers, reassurance, impaired functioning, and intrusive thoughts.\u003c/p\u003e"},{"header":"Materials \u0026 Methods","content":"\u003cp\u003e\u003cem\u003eProcedure \u0026amp; Participants\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTo validate the Fear of Cancer Recurrence Inventory (FCRI by Simard \u0026amp; Savard in the Hindi language via the English version of the FCRI of Lebel et al. (2016), the acceptance level in Hindi-speaking cancer patients was studied, and aspects of the psychometric properties of the FCRI were selected. Standard procedures were adapted, and an attempt was made to translate and assess the validity of the FCRI-Hindi (FCRI-H) version via the following steps: a) forward-backward translation, b) pilot testing of the FCRI-H, c) establishing cross-cultural equivalence and d) measuring selected aspects of psychometric properties. The study sample was collected via purposive sampling from a private hospital and informed consent was obtained from all the participants involved in the study. For pilot testing thirty patients were recruited followed by a sample of 100 patients diagnosed with cancer (heterogeneous) who were recruited from the OPD, IPD and daycare departments of the Department of Oncology. Patients were recruited if they were aged between 18 years and 85 years, were both sexes, were diagnosed with cancer and were aware of their illness irrespective of recurrence and metastasis. Patients with the ability to read, speak and understand English/ Hindi or bilingualism were included. Patients who had any significant neurological illness and the presence of any physical illness or psychiatric comorbidity at present were excluded as this might have contributed to the aim of the study.\u003c/p\u003e\u003cp\u003eSemi structured interviews were conducted with the focus on socio-demographic details, which were subsequently corroborated from case files, and any discrepancies led to the exclusion of those sample data. To measure bilingual levels, patients were asked to rate themselves on a 0–10 Likert rating scale ranging from ‘not at all’ (0) to ‘completely bilingual’ (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Patients were eligible when they rated themselves having a score of 5 or more on the level of bilingualism.\u003c/p\u003e\u003cp\u003e\u003cem\u003eMeasures\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eFear of Cancer Recurrence Inventory (FCRI)\u003c/em\u003e: The FCRI is a 42-item scale that evaluates seven aspects associated with fear of cancer recurrence in the past month: potential stimuli (triggers), the presence and severity of intrusive thoughts, emotional disturbance, and the impact of fear of cancer recurrence on important areas including functioning capacity; insight levels including self-criticism; coping strategies; and reassurance seeking. Ratings were performed on a Likert scale ranging from not at all (0) to all the time (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Scores can be obtained separately for the total scale and each subscale (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Reverse scoring was performed for item 13: “I believe that cancer is cured, and cancer will not come back”. A higher score indicates a greater level of fear of cancer recurrence. A score of 13 is the cutoff score. The original French version has internal consistency of .75-0.91 and test-retest reliability ranging from .58-0.83 across subscales. It has a convergent validity of .69 to .77 across the Illness Worry Scale (r = .68), the Fear of Cancer Recurrence Questionnaire (r = .71) and the Concerns About Recurrence Scale (r = .77). Concurrent validity ranges from (r = .43 to .77) and divergent validity ranges from (r = .20 to .36). The English version has Cronbach’s alpha of .71-0.94 and test-retest reliability of r = 0.88–0.94 across the subscales.\u003c/p\u003e\u003cp\u003eTo reduce the chances of response bias, the trial-making test (TMT) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), part A was adapted as a distraction technique and presented between both the versions of the FCRI, and time was not calculated.\u003c/p\u003e\u003cp\u003e\u003cem\u003eTranslation\u003c/em\u003e\u003c/p\u003e\u003cp\u003ePermission for translation into Hindi was led by the Simard \u0026amp; Savard. Standardized forward–backward. procedure was adapted. Independent Hindi translators (n = 3) were recruited for forward translations. To evaluate the semantics of the translated version the pooled responses were submitted to three mental health experts fluent in Hindi and English. The experts suggested modifications to use word cancer in Hindi or to use its Hindi term. The translators and mental health professionals were consulted before a consensus was reached and the Hindi term for cancer was retained. Three English translators fluent in Hindi were blinded to the original version for backward translation. Discrepancies related to specific wording and its meaning were identified in relation to the items. Finally, minor modifications were completed, and a consensus was reached for the Hindi version after discussion. The randomization of questions (between and within) was performed by computer-generated random numbers in Microsoft Excel for the Hindi version to reduce response bias and to improve overall data quality.\u003c/p\u003e\u003cp\u003e\u003cem\u003ePilot testing\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThirty heterogeneous cancer patients from the Department of Oncology of the hospital were pilot tested on the Hindi version. Before recruiting a brief interview was held with individuals suffering from cancer to determine if they met the inclusion and exclusion criteria. Individuals were briefed about the study and written informed consent was obtained, in which the nature of the illness, rationale for the current pilot study, and confidentiality issues including voluntary control were explained to the individual, and queries were clarified. The initial interview took approximately 10 minutes. Once the criterion was met the semi structured interview focused on the participants’ a) sociodemographic details, b) awareness of their illness, c) onset and duration of illness. Semi structured interviews helped the researcher recruit the participants to study and understand their current psychological state (see supplementary file 1), which helped in planning appropriate referrals.\u003c/p\u003e\u003cp\u003eFollowing the completion of the Hindi questionnaire, researchers evaluated the clarity of the following a) instructions, b) items, and c) answer formats. The participants rated their answers on the following basis: i) difficulty in understanding, ii) difficulty in answering, iii) the presence of confusing statements/items/words, iv) finding any item upsetting/offensive, and v) feeling that there was any need to rephrase the statement/item; if yes, then an alternative formulation was invited and recorded for items or words for which they were unclear. This process took approximately 15–20 minutes. No further changes were made, as the participants did not claim problems with any of the items or instructions (see supplementary file 1).\u003c/p\u003e\u003cp\u003e\u003cem\u003eCross-Cultural Validation\u003c/em\u003e\u003c/p\u003e\u003cp\u003eVallerand(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) has recommended adapting bilingual participants to assess cultural equivalence before establishing the psychometric properties of the translated version in one of his six steps for validation. Haccoun (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) suggested administering both versions of the questionnaire to bilingual participants in randomized order to ensure semantic equivalence. Considering the recommendations and to ensure counterbalanced approach, 100 participants who agreed to participate and met the inclusion-exclusion criteria were randomly assigned in phase- I to complete both versions of the FCRI (Hindi and English) either of which was administered first followed by a trial-making test in between as a distraction to reduce the likelihood of response bias and mechanical answers.\u003c/p\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eThe data was verified and examined using standard procedures. SPSS version 25.0 software was used for analysis. The psychometric properties of the FCRI-H were established via various steps. Descriptive statistics were performed to determine the means and medians. Correlation- coefficients between subcomponents were calculated. Three-way interaction was assessed to understand the relationships among items, language (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and randomization. As the data are exceedingly small (due to a lack of resources and time) for confirmatory factor analysis (CFA), Bartlett’s test of sphericity was performed before calculating the CFA. CFA was used to assess the construct validity and replicate the original factor structure of the English version of the FCRI (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The coefficient alpha was established for the subscales and total scale of the FCRI and internal consistency, and the item-total correlation coefficient was also calculated in this phase.\u003c/p\u003e\u003cp\u003e\u003cem\u003eEthical consideration\u003c/em\u003e\u003c/p\u003e\u003cp\u003e Written informed consent was obtained from the participants. The participants had the right to discontinue their involvement as per their decisions. For significant information elicited during the assessment, the appropriate intervention was planned or was referred to team psychologist or oncologist.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis section provides description of the participants (n\u0026thinsp;=\u0026thinsp;100) assigned to test validation of the FCRI. It also includes descriptions of pilot tests performed on a sample of 30 participants undergoing cancer treatment.\u003c/p\u003e\u003cp\u003e\u003cem\u003ePilot testing\u003c/em\u003e\u003c/p\u003e\u003cp\u003eForty-four participants were approached by the researcher, out of whom thirty heterogeneous cancer patients agreed to participate in the pilot-study, the majority of whom were females (56.7%), graduates (53.3%), married (76.6%), employed (36.7%), Hindu by religion (80%), of middle socioeconomic status (63.3%), lived in joint families (53.3%) and hailed from urban areas (96.7%) with a mean age of 55 years (range: 26\u0026ndash;74), a mean age of onset of 53.3 years (range: 25\u0026ndash;73), a mean duration of illness of 11.8 months (range: 1\u0026ndash;48). The majority of patients with a breast cancer diagnosis (30%) had not undergone surgery (60%), and 70% did not experience recurrent episode. All the patients (100%) were receiving chemotherapy. On \u003cem\u003eFacets of Interview\u003c/em\u003e, most participants reported that the questionnaire was easy to answer (70%), easy-to-understand (76.7%), not confusing (93.3%), upsetting/offensive (80%), and did not need to rephrase (100%) (see supplementary file 1).\u003c/p\u003e\u003cp\u003e\u003cem\u003eCross-cultural validation\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIn total, one hundred and twenty-eight patients were approached by the researcher, of whom twenty-eight patients refused to participate in the study for various reasons (not interested, health concerns or worries and being uncomfortable in sharing or talking about illness), leaving a sample of 100 patients. Patients were assessed via both the Hindi and English versions of the questionnaire. The majority of patients were females (66%), married (86%), Hindu by religion (89%), graduated (62%), homemakers (31%), had middle socioeconomic status (71%), hailing from an urban background (99%) and lived in a nuclear family (56%). The mean age of the participants was 56.31\u0026thinsp;\u0026plusmn;\u0026thinsp;12.85 years, the age of onset was 54.04\u0026thinsp;\u0026plusmn;\u0026thinsp;12.84, the duration of illness was 4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58, and the mean stage was 2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79 and the number of chemotherapy cycles was 7.66\u0026thinsp;\u0026plusmn;\u0026thinsp;7.17 (see supplementary file 2).\u003c/p\u003e\u003cp\u003e\u003cem\u003ePsychometric properties\u003c/em\u003e\u003c/p\u003e\u003cp\u003eA lack of relationship between the two versions was observed i.e., three-way interaction (Items X Language X Randomization) was not significant (F\u0026thinsp;=\u0026thinsp;2.13, p\u0026thinsp;\u0026lt;\u0026thinsp;.63), no significance (Item X Randomization) was present (F\u0026thinsp;=\u0026thinsp;0.78, p\u0026thinsp;\u0026lt;\u0026thinsp;.64) and no significance (Item X Language) was observed (F\u0026thinsp;=\u0026thinsp;0.92, p\u0026thinsp;\u0026lt;\u0026thinsp;.86) indicating that the questionnaire items were not influenced by language or by the randomization of the items or two versions (Hindi and English).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the inter-correlations between the total score and the factors of the FCRI and reliability indices. Like the English version of the FCRI (Lebel et al., 2016), the FCRI-Hindi total and subscale scores range from 0.22\u0026ndash;0.88 and 0.29\u0026ndash;0.73 of item-total correlations, respectively, indicating that the factors measured by the FCRI are related to the overall score. A higher correlation indicates significant contributors to the overall assessment of FCR. The Cronbach\u0026rsquo;s alpha coefficients range from 0.63 to 0.83 and 0.96 for the subscales and total scale of the FCRI, respectively, and are significant at the 0.01 level. The items within each subscale and the total scale relaibly measure the same underlying concept reliably.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInteritem correlations between factors and Cronbach\u0026rsquo;s alpha.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFCRI Factors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eF1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eF2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eF5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eF7\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eCorrected item-total correlations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eCronbach\u0026rsquo;s alpha\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF1-Triggers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.73*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.64*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.54*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.65*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.57*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.24*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e\u003cp\u003e.59-.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF2-Severity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.73*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.56*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.70*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.55*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.30*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.83*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e\u003cp\u003e.54-.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF3-Psychological Distress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.56*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.76*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.41*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.34*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.74*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e\u003cp\u003e.47-.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF4-Coping Strategies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.54*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.30*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.39*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.67*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e\u003cp\u003e.22-.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF5-Functioning Impairments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.41*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.30*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.70*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e\u003cp\u003e.43-.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF6-Insight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.29*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.79*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e\u003cp\u003e.49-.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF7-Reassurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.44*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e\u003cp\u003e.59-.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c10\"\u003e\u003cp\u003e.22-.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 (Table adapted from Simard and Savard, 2009).\u003c/p\u003e\u003cp\u003eTo ensure that CFA can be conducted due to small sample size, the factorability of 42 items and 7 subscales was examined. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was .84, above the recommended value of .60. Bartlett\u0026rsquo;s test of sphericity is a test of at least one significant correlation between 2 of the items studied and is significant (χ2 (351)\u0026thinsp;=\u0026thinsp;1086.000, p\u0026thinsp;\u0026lt;\u0026thinsp;.000) thus, the correlation matrix is sufficiently different from an identity matrix and correlations between variables are zero. The data were suitable for factor analysis or principal component analysis (PCA). Using total variance explained, seven original factors can be reduced to 3 underlying components, explaining 51% of the variance in the data. None of the subscales or items were removed because the minimum criterion of having a primary factor loading (0.04 or above) was met. The solutions for all the components were examined via orthogonal rotation. The factor loadings across the items of various subscales can be seen in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Medium to high corelations were observed across 42 items of the questionnaire, which were found to be loaded on three factors.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eExtracted components and factor loadings based on principal component analysis using orthogonal rotation.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eITEMS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eFactor Loading\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTriggers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.Television shows or newspaper articles about cancer or illness\u003c/p\u003e\u003c/td\u003e\u003ctd\u003e\u003c/td\u003e\u003ctd\u003e\u003cp\u003e.45\u003c/p\u003e\u003c/td\u003e\u003ctd\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. An appointment with doctor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Medical examinations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Conversation about cancer in general\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Seeing or hearing someone who is ill\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. Going to funeral or reading obituary section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. When I feel unwell physically or when I am sick\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. Generally, I avoid situations or things that makes me about FCR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSeverity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9. I am worried or anxious about the possibility of cancer recurrence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10. I am afraid of cancer recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11. I believe it is normal to be worried or anxious about the possibility of cancer recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12. When I think about the possibility of cancer recurrence, this triggers other unpleasant thoughts or images (such as death, suffering, the consequences for my family)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13. I believe that I am cured and that the cancer will not come back\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14. In your opinion, are you at risk of having a cancer recurrence?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15. How often do you think about the possibility of cancer recurrence?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16. How much time per day do you spend thinking about the possibility of cancer recurrence?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17. How long have you been thinking about the possibility of cancer recurrence?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePsychological Distress\u003c/b\u003e (When I think about cancer, I feel)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18. Worry, fear or anxiety\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19. Sadness, discouragement or disappointment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20. Frustration, anger or outrage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21. Helplessness or resignation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFear\u003c/b\u003e (My thoughts or fears about the possibility of cancer recurrence disrupt)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e22. My social or leisure activities (e.g. outings, sports, travel)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e23. My work or everyday activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24. My relationships with my partner, my family, or those close to me\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25. My ability to make future plans or set life goals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26. My state of mind or my mood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e27. My quality of life in general\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInsight\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e28. I feel that I worry excessively about the possibility of cancer recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e29. Other people think that I worry excessively about the possibility of cancer recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30. I think that I worry more about the possibility of cancer recurrence than other people who have been diagnosed with cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReassurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31. I call my doctor or other health professional\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e32. I go to the hospital or clinic for an examination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e33. I examine myself to see if I have any physical signs of cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCoping Strategies\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e34. I try to distract myself\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35. I try not to think about it, to get the idea out of my mind\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36. I pray, meditate or do relaxation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e37. I try to convince myself that everything will be fine or I think positively\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e38. I talk to someone about it\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e39. I try to understand what is happening and deal with it\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40. I try to find a solution\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41. I try to replace this thought with a more pleasant one\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e42. I tell myself \u0026ldquo;stop it\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e(FCRI Questionnaire adapted from Simard \u0026amp; Savard, 2009).\u003c/p\u003e\u003cp\u003eTable 3 Rotated component matrix across subscales.\u003c/p\u003e\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1757080896.png\" style=\"width: 621px;\"\u003e\u003c/p\u003e\u003cp\u003eThe factor loadings across the subscales are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Moderate to high correlations between three subscales (severity, psychological distress, and functioning impairments) and the psychological level (component 1) exist, moderate correlations between three subscales (trigger, insight, and coping strategies) and the insight level (component 2) exist, and high correlations between subscale reassurance and steps to address psychological distress (component 3) exist. Thus, different items on the FCRI are grouped into three main components, each measuring a different aspect of fear of cancer recurrence.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFear of cancer recurrence (FCR) has been commonly reported in cancer patients irrespective of demographic details and is frequently observed as one of the greatest causes of psychological distress in cancer patients, and survivors. Few studies have been conducted on FCR and a very few standardized and validated tools are available to assess the dimensionalities of FCR. This can be explained by the lack of validated tool in the Hindi language. It becomes more important as 43.63% of Indians converse in Hindi and claim it to be the first language.\u003c/p\u003e\u003cp\u003eThe findings suggest that the FCRI translation was readily acceptable for Hindi-speaking cancer patients. The results were cross-culturally equivalent to those of the English version, and the replication of the multidimensional structure was observed in the study. Confirmatory factor analysis results revealed the presence of seven subscales on three components, as observed in the English version. However, the results suggest that a reduction in factors and a few items could take place. Future studies can examine the reduction in items or subscales, and a shorter version could be established. The psychometric properties of the FCRI Hindi version are similar to those of the English version. Strong correlations among subscales were observed, replicating the original results. The total scores of the FCRI and seven subscales had moderate reliability coefficients above 0.65. Except for the reassurance subscale, a substantial difference was observed between the FCRI Hindi (r\u0026thinsp;=\u0026thinsp;0.44) and English (r\u0026thinsp;=\u0026thinsp;0.70) versions, indicating that the Indian population might have different reassurance strategies. Diverse socioeconomic backgrounds and support (education, family structure) can influence how participants perceive and cope with FCR. Diverse cultural beliefs about illness, health and recovery can directly influence participants\u0026rsquo; experiences as Indian traditional practices and beliefs about cancer differ from those of Western cultures.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, individuals with early stage cancer might not be adequately reflected because they were diagnosed with early stages of cancer. Second, a cut-off score could not be establish for the FCRI-H to identify clinically significant FCR, as it would provide researchers and physicians with greater insight into clinical diagnosis. Third, India is diverse in nature with varied cultures and beliefs, and psychometric properties were assessed mainly using only one small sample of a heterogeneous group of cancer patients, limiting the generalizability of the findings to other groups. Other psychometric properties were not assessed during this phase, and it would be advisable to assess the remaining psychometric properties in phase-II. Finally, the small sample size of CFA can lead to inaccurate estimates of factor loadings and possibly high, variance which may not be a true representative of a larger population.\u003c/p\u003e\u003cp\u003eOverall, this study revealed that the Hindi FCRI has acceptable psychometric properties. These findings support the use of this instrument among Hindi-speaking cancer patients. Future studies can focus on replicating the original and English versions of the factorial structure via a larger sample. Researchers can establish the psychometric properties of the FCRI across cancer sites and stages. The sensitivity of the FCRI to change can be studied in further clinical studies. The Hindi version of the FCRI can be correlated with other quality-of-life tools available in the Hindi language to assess cultural adpatibility. The FCRI can be a promising tool for assessing FCR among Hindi-speaking cancer patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFCR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFear of Cancer Recurrence\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFCRI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFear of Cancer Recurrence Inventory\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFCRI-H\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFear of Cancer Recurrence Inventory-Hindi\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTMT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTrail Making Test\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOPD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOut-Patient Department\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIPD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInpatient Department\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCFA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfirmatory Factor Analysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKMO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKaiser-Meyer-Olkin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePCA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePrincipal Component Analysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConsent to participate\u003c/h2\u003e\u003cp\u003e Ethical approval was obtained from the ethics committee of the Dr BLK-Max Hospital, Delhi according to Indian Council of Medical Research on Human Subjects. Informed consent was obtained from all the participants in the study.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eConflict of interest\u003c/h2\u003e\u003cp\u003eThe authors have no conflict of interest to declare.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll the authors have made substantial contributions to the study conception and design, acquisition of data, drafting/revising the manuscript critically for important intellectual content, and given final approval of the version to be published. KY made substantial contributions to the data collection, and analysis/interpretation. The first draft of the manuscript was written by KY and SPKJ, AA, commented on the previous versions of manuscript and given final approval of the version to be published. All authors have participated sufficiently in the work to take public responsibility for appropriate portions of the content and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy/integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe extend our sincere appreciation to Dr. Simard and Dr. Savard for granting permission to translate the tool into Hindi. We also wish to acknowledge Dr. BLK Hospital for providing the platform necessary to conduct this research.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript or supplementary information files.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGuntupalli AM, Selvamani Y, Maclennan SJ, Dilip TR. Health status and associated factors of middle-aged and older adult cancer survivors in India: results from the Longitudinal Ageing Study in India. BMC Cancer. 2022;22:1087. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12885-022-10111-7\u003c/span\u003e\u003cspan address=\"10.1186/s12885-022-10111-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeake RL, Gurrin LC, Hammond IG. 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Psychol Service Cent J. 1949;1:11\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVallerand RJ. Vers une m\u0026eacute;thodologie de validation trans-culturelle de questionnaires psychologiques: Implications pour la recherche en langue fran\u0026ccedil;aise. Can Psychol. 1989;30:662\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaccoun RR. Une nouvelle technique de v\u0026eacute;rification de l\u0026rsquo;\u0026eacute;quivalence de mesures psychologiques traduites. Revue qu\u0026eacute;b\u0026eacute;coise de psychologie. 1987;8:30\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cancer, Fear of Cancer Recurrence, Bilingual, FCRI","lastPublishedDoi":"10.21203/rs.3.rs-7149326/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7149326/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground:\u003cstrong\u003e \u003c/strong\u003eThis research investigated the acceptance level of the fear of cancer recurrence inventory, multidimensional measure in the Hindi language.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: First, the forward–backward translation of Hindi-speaking cancer patients was tested; second, cross-cultural equivalence was established with a sample of 30 bilingual (English and Hindi speaking) cancer patients; and finally, the psychometric properties of the questionnaire were measured in a sample of 100 heterogeneous Hindi-speaking patients. Cronbach’s alpha was used to establish internal consistency.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: The Hindi translation of the FCRI was well accepted, and item bias was not observed when it was administered to bilingual participants. The Cronbach’s alpha reliability of the scale was 0.93 (95% CI: 0.8–0.93), Spearman’s Brown Coefficient was 0.88 and KMO = 0.84 was significant at .05 level, suggesting significant construct validity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: The Hindi version of the FCRI is a well-accepted and reliable measure of fear of cancer recurrence in heterogeneous cancer patients for larger phase-II study.\u003c/p\u003e","manuscriptTitle":"Fear of Cancer Recurrence Inventory Validation in Hindi: Phase I","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-05 14:08:48","doi":"10.21203/rs.3.rs-7149326/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"14bbc072-7cd2-4a42-a415-3e948dce8300","owner":[],"postedDate":"September 5th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Withdrawn","date":"2026-05-10T22:37:42+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-10T22:53:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-05 14:08:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7149326","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7149326","identity":"rs-7149326","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}