Validation of the Edmonton Symptom Assessment System in Korean Patients With Cancer

Purpose: Previous work in Ontario demonstrated that 33% of patients with cancer with severe pain did not receive opioids at the time of their pain assessment. With efforts to increase symptom screening and management since then, the objective of this study was to examine temporal trends in opioid prescribing. Methods: The cohort was comprised of Ontario residents ≥ 65 years of age with a cancer history who were eligible for the government pharmacare program and had a pain assessment using the Edmonton Symptom Assessment System. Use of the Edmonton Symptom Assessment System is part of a provincial initiative to screen ambulatory patients with cancer for symptoms. Annually between 2007 and 2013, we used the date of an individual’s highest pain score as the index date to calculate annual opioid prescription rates for claims within 30 days before and up to 7 days after the index date. A logistic regression model evaluated the association between index year and odds of receiving an opioid prescription. Results: During the study period, the number of individuals undergoing symptom assessment annually increased more than eight-fold. Opioid prescription rates were directly related to pain scores, but there was an annual 5% relative decrease in the odds of receiving an opioid prescription during the era from 2009 to 2013. Conclusion: We are doing better at screening for pain, but this has not led to an increase in analgesic intervention for those identified. Additional work is required to determine what opioid prescribing rate is optimal to ensure we are not missing opportunities to improve patient comfort.

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The Optimal Cutoff Point for Expressing Revised Edmonton Symptom Assessment System Scores as Binary Data Indicating the Presence or Absence of Symptoms

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118775660 ◽

2018 ◽

Vol 35 (11) ◽

pp. 1390-1393 ◽

Cited By ~ 9

Author(s):

Jun Kako ◽

Masamitsu Kobayashi ◽

Yusuke Kanno ◽

Asao Ogawa ◽

Tomofumi Miura ◽

...

Keyword(s):

Binary Data ◽

Area Under The Curve ◽

Symptom Assessment ◽

Physical Symptoms ◽

Assessment System ◽

Cutoff Point ◽

Optimal Cutoff ◽

Edmonton Symptom Assessment System ◽

Patients With Cancer ◽

Optimal Cutoff Point

Context: Terminally ill patients with cancer experience various physical and emotional symptoms that have a negative impact on quality of life and activities of daily living. Recently, revised Edmonton Symptom Assessment System (ESAS-r) scores have been proposed for assessing symptoms in terminally ill patients with cancer. Objective: To determine the optimal cutoff point for expressing ESAS-r scores as binary data, indicating the presence or absence of symptoms. Methods: We conducted a retrospective study of patients hospitalized in the palliative care unit of our hospital between September 1, 2014 and May 31, 2015. To determine the optimal cutoff point for expressing ESAS-r scores as binary data, indicating the presence or absence of 6 physical symptoms (“pain,” “tiredness,” “drowsiness,” “nausea,” “lack of appetite,” and “dyspnea”), the sensitivity and specificity of each measurement were calculated. Cutoff points were estimated using receiver operating characteristic curve analysis. Results: Data from 157 patients who performed the self-assessment in ESAS-r scores were analyzed. The mean age was 66.5 years. Approximately 60.0% of patients were male. The optimal cutoff point for pain, tiredness, drowsiness, nausea, lack of appetite, and dyspnea was 4, 4, 4, 2, 5, and 4, respectively. The area under the curve for tiredness, nausea, and dyspnea was >0.70, followed in order by pain, lack of appetite, and drowsiness. The area under the curve for drowsiness was 0.55. Conclusion: Our results suggest that physical symptoms other than drowsiness could potentially predict ESAS-r score severity.

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The Accuracy of the Edmonton Symptom Assessment System for the Assessment of Depression in Patients With Cancer: A Systematic Review and Meta-Analysis

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909117745292 ◽

2017 ◽

Vol 35 (4) ◽

pp. 731-739 ◽

Cited By ~ 4

Author(s):

Sorawit Boonyathee ◽

Kittiphon Nagaviroj ◽

Thunyarat Anothaisintawee

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Symptom Assessment ◽

Assessment System ◽

Edmonton Symptom Assessment System ◽

Patients With Cancer

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Tolerability of the combination of ginger (Zingiber officinalis), gentian (Gentiana lutea) and turmeric (Curcuma longa) in patients with cancer-associated anorexia

Journal of Complementary and Integrative Medicine ◽

10.1515/jcim-2013-0064 ◽

2015 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Michael Sanatani ◽

Jawaid Younus ◽

Larry Stitt ◽

Nazish Malik

Keyword(s):

Curcuma Longa ◽

Symptom Assessment ◽

Assessment System ◽

Common Symptom ◽

Edmonton Symptom Assessment System ◽

Future Studies ◽

Patients With Cancer ◽

Gentiana Lutea ◽

Exploratory Data ◽

Unacceptable Toxicity

Abstract: Anorexia is a common symptom for patients with advanced cancer. Gentian, ginger, and turmeric have traditionally been used to stimulate appetite. We tested these agents in combination, in a pilot study to assess tolerability in patients indicating 4/10 or worse anorexia on the Edmonton Symptom Assessment System, and who were not currently on chemotherapy. We collected exploratory data on the patient’s appetite using a visual analogue scale.: Between 2009 and 2012, 17 patients were enrolled in arm 1 (turmeric 1 g and ginger 1 g orally twice daily, and: In arm 1, seven patients (41%) completed treatment. Seven patients (41%) stopped early because of unacceptable toxicity or patient-initiated discontinuation, and 3 stopped because of other reasons. All patients in arm 2 stopped taking the study medication within few days of starting the treatment, leading the study committee to recommend stopping the trial. The most common adverse effects attributed to study drugs were nausea (6 patients), vomiting (3), fatigue (3), diarrhea (2) and bloating (2). There was no statistically significant effect seen on appetite.: At the doses used in this study, the combination of ginger, turmeric, and gentian is not tolerated well in cancer patients. Future studies should use fewer agents or lower doses.

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Trajectory of Performance Status and Symptom Scores for Patients With Cancer During the Last Six Months of Life

Journal of Clinical Oncology ◽

10.1200/jco.2010.30.7173 ◽

2011 ◽

Vol 29 (9) ◽

pp. 1151-1158 ◽

Cited By ~ 227

Author(s):

Hsien Seow ◽

Lisa Barbera ◽

Rinku Sutradhar ◽

Doris Howell ◽

Deborah Dudgeon ◽

...

Keyword(s):

Performance Status ◽

Symptom Assessment ◽

Well Being ◽

Assessment System ◽

Assessment Tools ◽

Future Research ◽

Patients With Cancer ◽

Average Pain ◽

Observational Cohort ◽

Over Time

Purpose Ontario's cancer system is unique because it has implemented two standardized assessment tools population-wide to improve care: the Edmonton Symptom Assessment System (ESAS) measures severity of nine symptoms (scale 0 to 10; 10 indicates the worst) and the Palliative Performance Scale (PPS) measures performance status (scale 0 to 100; 0 indicates death). This article describes the trajectory of ESAS and PPS scores 6 months before death. Patients and Methods Observational cohort study of cancer decedents between 2007 and 2009. Decedents required ≥1 ESAS or PPS assessment in the 6 months before death for inclusion. Outcomes were the decedents' average ESAS and PPS scores per week before death. Results Ten thousand seven hundred fifty-two (ESAS) and 7,882 (PPS) decedents were included. The mean age was 65 years, half were female, and approximately 75% of assessments occurred in cancer clinics. Average PPS score declined slowly over the 6 months before death, starting at approximately 70 and ending at 40, declining more rapidly in the last month. For ESAS symptoms, average pain, nausea, anxiety, and depression scores remained relatively stable over the 6 months. Conversely, shortness of breath, drowsiness, well-being, lack of appetite, and tiredness increased in severity over time, particularly in the month before death. More than one third of the cohort reported moderate to severe scores (ie, 4 to 10) for most symptoms in the last month of life. Conclusion In this large outpatient cancer population, trajectories of mean ESAS scores followed two patterns: increasing versus generally flat. The latter was perhaps due to available treatment (eg, prescriptions) for those symptoms. Future research should prioritize addressing symptoms that worsen over time.

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Avaliação do instrumento Edmonton Symptom Assessment System em cuidados paliativos: revisão integrativa

Revista Gaúcha de Enfermagem ◽

10.1590/s1983-14472010000400024 ◽

2010 ◽

Vol 31 (4) ◽

pp. 785-793 ◽

Cited By ~ 2

Author(s):

Daiane da Rosa Monteiro ◽

Maria Henriqueta Luce Kruse ◽

Miriam de Abreu Almeida

Keyword(s):

Retrieval System ◽

Medical Literature ◽

Symptom Assessment ◽

Assessment System ◽

Literature Analysis ◽

Edmonton Symptom Assessment System

Cuidados Paliativos (CP) são prestados a pacientes fora de possibilidades terapêuticas de cura, tendo como foco o controle dos sintomas e melhora da qualidade de vida. A Edmonton Symptom Assessment System (ESAS) é um instrumento para avaliar e monitorar nove sintomas físicos e psicológicos em pacientes de CP. O estudo objetiva realizar revisão integrativa acerca da avaliação dos profissionais de saúde e/ou pacientes quanto ao uso da ESAS em pacientes oncológicos em Cuidados Paliativos. Foram localizados oito artigos no Medical Literature Analysis and Retrieval System Online (MEDLINE) entre 1998 e 2009. Os resultados mostraram que apesar de haver poucos estudos sobre este assunto, a ESAS é um instrumento válido para detectar e monitorar sintomas nos CP, apresentando algumas limitações. Os resultados apontam para a importância da continuidade do estudo de tradução e adaptação transcultural desta escala para o português do Brasil.

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Prescreening of Patient-reported Symptoms using the Edmonton Symptom Assessment System (ESAS) in Outpatient Palliative Cancer Care

10.21203/rs.2.16484/v1 ◽

2019 ◽

Author(s):

Garden Lee ◽

Han Sang Kim ◽

Si Won Lee ◽

Eun Hwa Kim ◽

Bori Lee ◽

...

Keyword(s):

Palliative Care ◽

Cancer Care ◽

Severe Symptom ◽

Symptom Burden ◽

Symptom Assessment ◽

Assessment System ◽

Advanced Cancer Patients ◽

Edmonton Symptom Assessment System ◽

Patient Reported

Abstract Background: Although early palliative care is associated with a better quality of life and improved outcomes in end-of-life cancer care, the criteria of palliative care referral are still elusive. Methods: We collected patient-reported symptoms using the Edmonton Symptom Assessment System (ESAS) at the baseline, first, and second follow-up visit. The ESAS evaluates ten symptoms: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, appetite, and wellbeing. A total of 71 patients were evaluable, with a median age of 65 years, male (62%), and the Eastern Cooperative Oncology Group (ECOG) performance status distribution of 1/2/3 (28%/39%/33%), respectively. Results: Twenty (28%) patients had moderate/severe symptom burden with the mean ESAS ≥5. Interestingly, most of the patients with moderate/severe symptom burdens (ESAS ≥5) had globally elevated symptom expression. While the mean ESAS score was maintained in patients with mild symptom burden (ESAS<5; 2.7 at the baseline; 3.4 at the first follow-up; 3.0 at the second follow-up; P =0.117), there was significant symptom improvement in patients with moderate/severe symptom burden (ESAS≥5; 6.5 at the baseline; 4.5 at the first follow-up; 3.6 at the second follow-up; P <0.001). Conclusions: Advanced cancer patients with ESAS ≥5 may benefit from outpatient palliative cancer care. Prescreening of patient-reported symptoms using ESAS can be useful for identifying unmet palliative care needs in advanced cancer patients.

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Dyspnea is associated with overall symptom burden in patients with chronic respiratory insufficiency

10.21203/rs.3.rs-73163/v1 ◽

2020 ◽

Author(s):

Heidi Anniina Rantala ◽

Sirpa Leivo-Korpela ◽

Juho T. Lehto ◽

Lauri Lehtimäki

Keyword(s):

Respiratory Insufficiency ◽

Depression Scale ◽

Symptom Burden ◽

Symptom Assessment ◽

Assessment System ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Edmonton Symptom Assessment System ◽

Symptom Screening ◽

Chronic Respiratory Insufficiency

Abstract Objective Patients with chronic respiratory insufficiency suffer from many symptoms together with dyspnea. We evaluated the association of dyspnea with other symptoms in patients with chronic respiratory insufficiency due to chronic obstructive pulmonary disease or interstitial lung disease. Results This retrospective study included 101 patients. Dyspnea was assessed with modified Medical Research Council dyspnea questionnaire (mMRC) and other symptoms with Edmonton Symptom Assessment System (ESAS) and Depression Scale (DEPS). Patients with mMRC 4 (most severe dyspnea) compared to those with mMRC 0–3 reported higher median (IQR) symptom scores on ESAS in e.g. dry mouth (7.0 (4.0–8.0) vs. 3.0 (1.0–6.0), P < 0.001), tiredness (6.0 (3.0–7.0) vs. 3.0 (1.0–5.0), P < 0.001) and anxiety (3.0 (0.0-5.5) vs. 1.0 (0.0–3.0), P = 0.007). Patients with mMRC 4 were more likely to reach the DEPS threshold for depression compared to those with mMRC 0–3 (42.1% vs. 20.8%, P = 0.028). In conclusion, patients with chronic respiratory insufficiency need comprehensive symptom screening with relevant treatment, as they suffer from many severe symptoms worsening with increased dyspnea.

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