title: Concerns of former breast cancer patients about disease recurrence: a validation and prevalence study.
abstract: OBJECTIVE
  The present study has three aims: first, to evaluate the psychometric properties of the Dutch version of the CARS (CARS-DLV). Second, to measure the prevalence of concerns about disease recurrence in former breast cancer patients and identify potential predictors and third, to establish how fear of recurrence was effecting quality of life.
  
  
  METHODS
  A prospective study was carried out on breast cancer patients (n=136) who had undergone curative treatment. Eligible patients completed an extensive questionnaire consisting of the CARS (fear of recurrence), HADS (anxiety and depression), BPI (pain), RAND (quality of life), LOT (optimism) and the PCS (catastrophizing).
  
  
  RESULTS
  This study confirmed the good internal consistency, test-retest stability and construct validity of the CARS (Dutch Language version). Moderate to high levels of fear of disease recurrence were found in 56% of 136 breast cancer survivors. Worries about health and death were the most prominent. Pain was a strong predictor of overall fear and of fear on the four sub domains of the CARS. The prevalence of fear decreased significantly with age. Education level, living arrangements and time since the last treatment did not predict the prevalence of overall fear. Fear of recurrence was negatively correlated with quality of life.
  
  
  CONCLUSIONS
  The CARS-DLV proved to be a valuable instrument to measure women's' concerns about breast cancer recurrence. More than half of former breast cancer patients indicated moderate to severe concerns about disease recurrence. Health and death worries were the most prominent. The levels of worry were independent of the time since diagnosis.
authors.affiliation: Pain Management and Research Center, University Hospital Maastricht, Maastricht, The Netherlands. MVDB@adcc.azm.nl
authors.forename: Marieke H J
authors.initials: MH
authors.lastname: van den Beuken-van Everdingen
authors.forename: Madelon L
authors.initials: ML
authors.lastname: Peters
authors.forename: Janneke M
authors.initials: JM
authors.lastname: de Rijke
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.forename: Maarten
authors.initials: M
authors.lastname: van Kleef
authors.forename: Jacob
authors.initials: J
authors.lastname: Patijn
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D001943:Breast Neoplasms / Q000453:epidemiology / Q000523:psychology*; D002605:Character; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005239:Fear; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000523:psychology*; D009426:Netherlands; D010147:Pain Measurement / Q000523:psychology; D011446:Prospective Studies; D011594:Psychometrics / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology; D015203:Reproducibility of Results; D012307:Risk Factors; D012803:Sick Role; D011795:Surveys and Questionnaires