Cancer Treatment Survey (CaTS)

Abstract

The Cancer Treatment Survey (CaTS) is a specialized psychometric instrument designed to measure the extent of a patient’s preparation for upcoming cancer treatments, specifically chemotherapy and radiotherapy. Recognizing the high prevalence of pre-treatment anxiety and potential distressing psychosocial and physical sequelae, the CaTS provides clinicians with a standardized way to assess patient needs regarding information and coping assistance before treatment initiation. Developed through rigorous item selection and factor analysis, the survey is divided into two reliable subscales: sensory/psychological concerns and procedural concerns. The results derived from the CaTS enable healthcare practitioners to implement targeted interventions aimed at improving patient preparation and reducing treatment-related distress.

Keywords

Cancer Treatment Survey, CaTS, chemotherapy, radiotherapy, patient preparation, psycho-oncology, anxiety, procedural concerns, psychological concerns, coping, scale validation.

Authors

Schofield, P., et al.

Purpose

The primary purpose of the Cancer Treatment Survey (CaTS) is to quantitatively measure the level of preparation and informational needs experienced by patients who are about to undergo cancer treatment, such as chemotherapy or radiotherapy.

The scale serves as a clinical tool to identify specific areas where patients require greater assistance or information, thereby addressing the common issue of high pre-treatment anxiety. By capturing patient concerns regarding both the physical side effects and the procedural aspects of treatment, CaTS allows healthcare providers to tailor psychological and educational interventions, ultimately improving the overall patient experience and care pathway.

Construct

The CaTS measures the construct of Patient Preparation for Cancer Treatment, which encompasses the perceived need for assistance and information regarding the upcoming medical procedures and their consequences. This preparation is conceptualized as having two distinct dimensions, validated through factor analysis.

These dimensions reflect the multifaceted nature of pre-treatment distress and include: Sensory/Psychological Concerns, which relate to worries about potential physical discomfort, side effects (like fatigue, nausea, hair loss), and emotional distress (like depression or general worry); and Procedural Concerns, which relate to the need for clear, step-by-step information about the logistics, process, and behavioral requirements before, during, and after treatment.

Validity

The validity of the CaTS was established during its development phase through psychometric testing. A key aspect of its validation involved establishing Divergent validity against established measures of general distress.

Specifically, Divergent validity was confirmed by correlating both CaTS subscales with the Hospital Anxiety and Depression Scale (HADS), particularly the HADS-Anxiety (HADS-A) and HADS-Depression (HADS-T) subscales. The resulting correlation coefficients were consistently low (r < 0.30 for all comparisons), indicating that while the CaTS measures relevant distress related to treatment preparation, it is statistically distinct from general trait anxiety or depression measured by the HADS, supporting its unique clinical utility.

Reliability

The reliability of the Cancer Treatment Survey (CaTS) was assessed using internal consistency measures, demonstrating excellent reliability across both derived subscales.

Internal reliability was confirmed by calculating Cronbach’s alpha coefficients for the Sensory/Psychological Concerns subscale and the Procedural Concerns subscale. Both subscales achieved an alpha value exceeding 0.90, indicating a high degree of internal consistency where items within each factor measure the same underlying construct effectively. Furthermore, the average inter-item correlation for each scale exceeded the threshold of 0.30, providing additional evidence of strong measurement reliability.

Factor Analysis

The development of the CaTS involved a systematic item reduction process, where 11 initial items were removed. The subsequent factor analysis of the remaining items supported a clear two-factor solution, which defined the structure of the final instrument.

The final validated scale consists of 25 items distributed across two distinct factors: 11 items loaded onto the factor representing Sensory/Psychological Concerns, addressing emotional distress and physical side effects; and 14 items loaded onto the factor representing Procedural Concerns, addressing the need for information about the treatment process, logistics, and management of side effects. This two-factor model ensures the instrument captures the complexity of pre-treatment distress effectively.

Instrument

Test Type: Self-report questionnaire / Psychometric Scale

Format: The scale uses a 5-point Likert response format, ranging from 1 (Strongly Disagree) to 5 (Strongly Agree), assessing the extent to which the patient agrees they require more assistance or information for specific concerns.

Language Available: English (Original validation language)

Population Group: Adult cancer patients preparing to receive active treatment.

Age Group: Adults (with specific findings noting differences in those under 65 years).

Population Details: The scale is intended for individuals who have recently been diagnosed and informed about their upcoming chemotherapy or radiotherapy. The validation study noted that younger participants (under 65 years of age) reported significantly greater procedural concerns (p < 0.001; medium effect size) compared to older patients.

Test Methodology: Subscale scores are calculated by summing the participant’s responses for all items within that scale and dividing by the total number of items in that subscale. If there are missing responses, the mean of the non-missing items is used, provided that over half of the items in the scale have been completed (as per Fayers et al., 1998 methodology).

Keywords

Psycho-oncology, patient-reported outcomes (PROs), cancer care, treatment anxiety, psychosocial assessment, coping strategies, clinical psychology, psychometrics.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Not provided in source content.

Permissions & Fee and Test Year

Test Year: 2012 (Year of initial publication and validation).

Permissions/Fee: Specific usage permissions and fee information are not detailed in the source content, but usage typically requires citation of the key reference.

Reference’s

• Schofield, P., et al. (2012). Cancer Treatment Survey (CaTS): Development and validation of a new instrument to measure patients’ preparation for chemotherapy and radiotherapy. Psycho-Oncology. 21(3):307-315.
• Fayers, P. M., Curran, D., & Machin, D. (1998). Incomplete quality of life data in randomized trials: missing items and missing forms. Stat Med, 17(6), 679–696. (Referenced for scoring methodology regarding missing data).

Items of the Cancer Treatment Survey (CaTS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Cancer Treatment Scale (CaTS)

Before Treatment

• We would like to know how you have been feeling since being told about your upcoming treatment for cancer. This information will allow us to improve the way in which patients in your situation are treated.
• Please think about what hospital staff have done to help you cope better in this time before your treatment.
• Please circle the number between 1 and 5 that describes the extent to which you agree with each of the following statements.

Scaling: 1 = Strongly Disagree, 2 = Disagree, 3 = In Between, 4 = Agree, 5 = Strongly Agree

I would find it helpful if I received more assistance to cope with my:

• worries about the treatment
• uncertainty about what will happen during treatment
• worry that something might go wrong during or after treatment

I would find it helpful if I received more assistance to cope with my worries that the treatment might:

• make breathing difficult
• make me feel sicker
• make me really tired
• be physically unpleasant
• be uncomfortable
• make me lose my hair
• give me mouth ulcers
• make me constipated
• give me diarrhoea
• affect my sexuality
• make me feel depressed

I would find it helpful if I received more information about:

• things I can do to feel more in control during treatment
• the things I should do before treatment
• where to go in the hospital for treatment
• what the step by step process of treatment is
• how the treatment will feel when I have it
• the things I shouldn’t do during treatment
• sensations or experiences during treatment that I should discuss with the people providing my treatment.
• possible side-effects of treatment
• how to manage any side effects
• what things I can and can’t do following treatment
• what are abnormal sensations following treatment