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J Pain Symptom Manage. 2009 Apr;37(4):676-86. doi: 10.1016/j.jpainsymman.2008.04.011. Epub 2008 Sep 11.

Exploratory factor analysis of the Cancer Problems in Living Scale: a report from the American Cancer Society's Studies of Cancer Survivors.

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  • 1Behavioral Research Center, American Cancer Society, Atlanta, Georgia 30303, USA.


People diagnosed with cancer face a variety of problems, which can impact their quality of life (QoL). Identifying these problems is an important part of understanding how people adjust to cancer. This study identified the underlying factor structure of the Cancer Problems in Living Scale (CPILS), a 29-item measure of the problems that cancer survivors may face. Exploratory factor analysis was applied to data from 5155 cancer survivors included in the American Cancer Society's Study of Cancer Survivors-I (SCS-I), a national, population-based study of survivors of 10 different types of cancer. Results of the factor analysis identified four factors in the CPILS: 1) physical distress (PD) (Cronbach's alpha=0.84); 2) emotional distress (ED) (Cronbach's alpha=0.87); 3) employment/financial (EF) problems (Cronbach's alpha=0.78); and 4) fear of recurrence (FR) (Cronbach's alpha=0.84). The convergent and divergent validity of the factors is demonstrated by correlations with relevant measures of physical and emotional functioning. The four valid and reliable factors demonstrate the utility of the CPILS in both clinical and research settings. The emergence of a separate factor for FR shows that this is a unique aspect of the cancer survivor experience, distinct from general ED.

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