Identifying the key characteristics of clinical fear of cancer recurrence: an international Delphi study

Objective: Without an agreed‐upon set of characteristics that differentiate clinical from non‐clinical levels of fear of cancer recurrence (FCR), it is difficult to ensure that FCR severity is appropriately measured, and that those in need of intervention are identified. The objective of this study was to establish expert consensus on the defining features of clinical FCR.

Method: A three‐round Delphi was used to reach consensus on the defining features of clinical FCR. Sixty‐five experts in FCR (researchers, psychologists, physicians, nurses, allied health professionals) were recruited to suggest and rate potential features of clinical FCR. Participants who indicated they could communicate diagnoses within their clinical role were also asked to consider the application of established DSM‐5 and proposed ICD‐11 diagnostic criteria (Health Anxiety, Illness Anxiety Disorder, Somatic Symptom Disorder) to clinical FCR.

Results: Participants’ ratings suggested that the following 4 features are key characteristics of clinical FCR: 1) high levels of preoccupation; 2) high levels of worry; 3) that are persistent; and 4) hypervigilance to bodily symptoms. Of participants whose professional role allowed them to diagnose mental disorders 84% indicated it would be helpful to diagnose clinical FCR, but the use of established diagnostic criteria related to health anxiety or somatic‐related disorders to clinical FCR was not supported. This suggests that participants consider clinical FCR as a presentation that is specific to cancer survivors.

Conclusion: Clinical FCR was conceptualized as a multi‐dimensional construct. Further research is needed to empirically validate the proposed defining features.