The Malayalam version of fear of cancer recurrence-7 scale: A cross-sectional study on translation and validation among breast cancer survivors

ABSTRACT Background: Fear of cancer recurrence (FCR) affects up to 89% of survivors, impairing quality of life (QoL). The fear of cancer recurrence-7 (FCR-7) is a reliable tool, but no validated Malayalam version exists. Objectives: The primary objective was to translate and validate the Malayalam version of the FCR-7 (FCR-M) scale. The secondary objective was to identify factors influencing FCR and assess their impact on QoL. Materials and Methods: A cross-sectional study was conducted among 279 breast cancer survivors. Participants completed the FCR-7 and cancer worry scale (CWS) to measure FCR, and the functional assessment of cancer therapy-breast (FACT-B) to evaluate QoL. Psychometric testing assessed reliability, validity, and confirmatory factor analysis (CFA). Predictors of FCR were analyzed using multivariate models. Results: The FCR-M showed excellent validity (content validity index [CVI] = 0.97) and strong reliability (Cronbach’s alpha 0.83). FCR-7 scores correlated with CWS ( r = 0.603, P < 0.001). CFA confirmed a unidimensional structure with good model fit. Higher FCR-7 scores were inversely related to FACT-B scores ( r = -0.419, P < 0.001), indicating reduced QoL with elevated FCR. Independent predictors of higher FCR included nodal negativity (OR = 2.00, P, 0.007), premenopausal status (OR = 4.04, P < 0.001), and early tumor stage (OR = 3.039, P, 0.020). Conclusion: The FCR-M is a valid and reliable tool for assessing FCR in Malayalam-speaking breast cancer survivors. Younger, premenopausal women and those with early-stage disease are at higher risk, underscoring the need for FCR screening and psychological support in survivorship care.