Cross-sectional validity of a modified Edmonton symptom assessment system in dialysis patients: A simple assessment of symptom burden

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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Implementing a Patient-Reported Outcome Measure for Hemodialysis Patients in Routine Clinical Care

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.01840220 ◽

2020 ◽

Vol 15 (9) ◽

pp. 1299-1309 ◽

Cited By ~ 1

Author(s):

Jenna M. Evans ◽

Alysha Glazer ◽

Rebecca Lum ◽

Esti Heale ◽

Marnie MacKinnon ◽

...

Keyword(s):

Outcome Measure ◽

Symptom Burden ◽

Symptom Assessment ◽

Patient Reported Outcome ◽

Assessment System ◽

Edmonton Symptom Assessment System ◽

Patient Reported Outcome Measure ◽

Symptom Screening ◽

Patient Reported ◽

Patient Provider Communication

Background and objectivesThe Edmonton Symptom Assessment System Revised: Renal is a patient-reported outcome measure used to assess physical and psychosocial symptom burden in patients treated with maintenance dialysis. Studies of patient-reported outcome measures suggest the need for deeper understanding of how to optimize their implementation and use. This study examines patient and provider perspectives of the implementation process and the influence of the Edmonton Symptom Assessment System Revised: Renal on symptom management, patient-provider communication, and interdisciplinary communication.Design, setting, participants, & measurements Eight in-facility hemodialysis programs in Ontario, Canada, assessed patients using the Edmonton Symptom Assessment System Revised: Renal every 4–6 weeks for 1 year. Screening and completion rates were tracked, and pre- and postimplementation surveys and midimplementation interviews were conducted with patients and providers. A chart audit was conducted 12 months postimplementation.ResultsIn total, 1459 patients completed the Edmonton Symptom Assessment System Revised: Renal; 58% of eligible patients completed the preimplementation survey (n=718), and 56% of patients who completed the Edmonton Symptom Assessment System Revised: Renal at least once completed the postimplementation survey (n=569). Provider survey response rates were 71% (n=514) and 54% (n=319), respectively. Nine patients/caregivers from three sites and 48 providers from all sites participated in interviews. A total of 1207 charts were audited. Seven of eight sites had mean screening rates over 80%, suggesting that routine use of the Edmonton Symptom Assessment System Revised: Renal in clinical practice is feasible. However, the multiple data sources painted an inconsistent picture of the value and effect of the Edmonton Symptom Assessment System Revised: Renal. The Edmonton Symptom Assessment System Revised: Renal standardized symptom screening processes across providers and sites; improved patient and provider symptom awareness, particularly for psychosocial symptoms; and empowered patients to raise issues with providers. Yet, there was little, if any, statistically significant improvement in the metrics used to assess symptom management, patient-provider communication, and interdisciplinary communication.ConclusionsThe Edmonton Symptom Assessment System Revised: Renal patient-reported outcome measure may be useful to standardize symptom screening, enhance awareness of psychosocial symptoms among patients and providers, and empower patients rather than to reduce symptom burden.

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Performance Status and Symptom Scores of Women With Gynecologic Cancer at the End of Life

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e318291e5ef ◽

2013 ◽

Vol 23 (5) ◽

pp. 971-978 ◽

Cited By ~ 15

Author(s):

Lori Spoozak ◽

Hsien Seow ◽

Ying Liu ◽

Jason Wright ◽

Lisa Barbera

Keyword(s):

Cervical Cancer ◽

End Of Life ◽

Performance Status ◽

Gynecologic Cancer ◽

Symptom Burden ◽

Symptom Assessment ◽

Well Being ◽

Assessment System ◽

Edmonton Symptom Assessment System ◽

Symptom Scores

ObjectiveThe Palliative Performance Scale (PPS), which measures performance status (100 = best performance to 0 = dead), and the Edmonton Symptom Assessment System (ESAS), which measures severity of 9 symptoms, are routinely collected at ambulatory cancer visits in Ontario. This study describes the trajectory of scores in patients with gynecologic cancer in the last 6 months of life.MethodsAn observational study was conducted between 2007 and 2010. Patients had ovarian/fallopian tube, uterine, and cervical cancer and required 1 or more PPS or ESAS assessment in the 6 months before death. Outcomes were the average PPS and ESAS scores per week before death. Using logistic regression, we analyzed the odds ratio of reporting a moderate to severe score for each symptom.ResultsSeven hundred ninety-five (PPS) and 1299 (ESAS) patients were included. The average PPS score started at 70 and ended at 30, rapidly declining in the last 2 months. For ESAS symptoms, drowsiness, decreased well-being, lack of appetite, and tiredness increased in severity closer to death and were prevalent in more than 70% of patients in the last week of life. Patients with cervical cancer had increased odds of moderate to severe pain (1.74; 95% confidence interval, 1.30–2.32) compared with ovarian cancer.ConclusionsTrajectories of mean performance status had not reached the “end-of-life” phase until 1 week before death. A large proportion of the gynecologic cancer patients reported moderate to severe symptom scores as death approached. Pain was uniquely elevated in the cervical cancer cohort as death approached. Adequately managing the symptom burden appears to be a significant issue in end-of-life gynecologic care.

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Testing the feasibility of using the Edmonton Symptom Assessment System (ESAS) to assess caregiver symptom burden

Palliative & Supportive Care ◽

10.1017/s1478951517000098 ◽

2017 ◽

Vol 16 (1) ◽

pp. 14-22 ◽

Cited By ~ 10

Author(s):

Kimberson Tanco ◽

Marieberta Vidal ◽

Joseph Arthur ◽

Marvin Delgado Guay ◽

David Hui ◽

...

Keyword(s):

Financial Distress ◽

Concurrent Validity ◽

Care Center ◽

Symptom Burden ◽

Symptom Assessment ◽

Well Being ◽

Assessment System ◽

Cancer Center ◽

Edmonton Symptom Assessment System ◽

Outpatient Supportive Care

ABSTRACTObjective:Caregiver symptom assessment is not part of regular clinical cancer care. The ESAS (Edmonton Symptom Assessment System) is a multidimensional tool regularly used to measure symptom burden in patients but not caregivers. The objectives of the present study were to determine the feasibility of the ESAS in caregiver completion (defined as ≥ 9 of 12 items) and determine its concurrent validity with the Zarit Burden Interview–12 (ZBI–12).Method:We conducted a prospective study on 90 patient–primary caregiver dyads seen in an outpatient supportive care center in a cancer center. The 12 item ESAS–FS (financial–spiritual) was completed by the dyads along with other clinical and psychosocial measures.Results:The caregiver ESAS was found to be feasible (90/90 caregivers, 100% completed ≥ 9/12 items) and useful (66/90 caregivers, 73%) by caregivers to report their symptom burden. Some 68 of 90 (76%) caregivers had symptom distress scores ≥ 4 on at least one symptom. A significant association was found between the ESAS scores of caregivers and patients for fatigue (0.03), depression (<0.01), anxiety (<0.01), sleep (0.05), well-being (<0.01), financial distress (<0.01), spiritual pain (<0.01), and total ESAS score (<0.01). Concurrent validity with the ZBI–12 was not achieved (r = 0.53, p = 0.74). A significant correlation was found between caregiver ESAS scores and time spent feeding, housekeeping, total combined caregiver activities, and total ZBI–12 scores.Significance of results:The caregiver ESAS is a feasible tool and was found useful by our caregivers. Further research is needed to modify the ESAS based on caregivers' recommendations, and further psychometric studies need to be conducted.

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Using the Edmonton Symptom Assessment System to estimate symptom burden and severity in patients on dialysis and kidney transplant recipients

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2018.03.118 ◽

2018 ◽

Vol 109 ◽

pp. 125-126

Author(s):

M. Pokarowski ◽

S. Dano ◽

D. Toews ◽

N. Singh ◽

N. Edwards ◽

...

Keyword(s):

Kidney Transplant ◽

Symptom Burden ◽

Symptom Assessment ◽

Assessment System ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Edmonton Symptom Assessment System

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Multidisciplinary Health Care Professionals' Perceptions of the Use and Utility of a Symptom Assessment System for Oncology Patients

Journal of Oncology Practice ◽

10.1200/jop.2010.000015 ◽

2011 ◽

Vol 7 (1) ◽

pp. 19-23 ◽

Cited By ~ 27

Author(s):

Daryl Bainbridge ◽

Hsien Seow ◽

Jonathan Sussman ◽

Greg Pond ◽

Lorraine Martelli-Reid ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Symptom Burden ◽

Multidisciplinary Care ◽

Symptom Assessment ◽

Assessment System ◽

Oncology Patients ◽

Edmonton Symptom Assessment System ◽

Cancer Centers

This study examines the value of the Edmonton Symptom Assessment System (ESAS), a measure of symptom burden adopted by Ontario's cancer centers, among clinical teams and barriers to its use in the enhancement of multidisciplinary care.

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Baseline Edmonton Symptom Assessment System and survival in metastatic renal cell carcinoma

Current Oncology ◽

10.3747/co.25.3935 ◽

2018 ◽

Vol 25 (4) ◽

Cited By ~ 4

Author(s):

J. Graham ◽

J. Gingerich ◽

P. Lambert ◽

A. Alamri ◽

P. Czaykowski

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Metastatic Renal Cell Carcinoma ◽

Renal Cell ◽

Symptom Burden ◽

Symptom Assessment ◽

Assessment System ◽

Prognostic Information ◽

Edmonton Symptom Assessment System ◽

Patient Reported

Background Baseline symptom burden as measured using the Edmonton Symptom Assessment System (esas), a patient-reported, validated, and reliable tool measuring symptom severity in 9 separate domains, might yield prognostic information in patients receiving treatment for metastatic renal cell carcinoma (mrcc) and might add to the existing prognostic models.Methods In this retrospective single-centre cohort study, we included patients receiving first-line sunitinib therapy for mrcc between 2008 and 2012. Baseline variables included information relevant to the pre-existing prognostic models and pre-treatment esas summation scores (added together across all 9 domains), with higher scores representing greater symptom burden. We used Kaplan–Meier curves and Cox regression modelling to determine if symptom burden can provide prognostic information with respect to overall survival.Results We identified 68 patients receiving first-line therapy for mrcc. Most had intermediate- or poor-risk disease based on both the Memorial Sloan Kettering Cancer Center (mskcc) and the International Metastatic Renal Cell Carcinoma Database Consortium (imdc) models. The median baseline esas summation score was 16 (range: 6–57). In univariable analysis, the hazard ratio for overall survival was 1.270 (p = 0.0047) per 10-unit increase in summation esas. In multivariable analysis, the hazard ratio was 1.208 (p = 0.0362) when controlling for mskcc risk group and 1.240 (p = 0.019) when controlling for imdc risk group.Conclusions Baseline symptom burden as measured by esas score appears to provide prognostic information for survival in patients with mrcc. Those results should encourage the investigation of patient-reported symptom scales as potential prognostic indicators for patients with advanced cancer.

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