A modified Edmonton Symptom Assessment Scale for symptom clusters in radiation oncology patients

Abstract

Patient‐reported outcomes regarding symptom burden may provide valuable information in addition to physician assessment. Systematic collection of patient‐reported outcomes may be an important metric to identify unmet needs and improve quality of patient care. To understand common symptoms of patients seen in radiation oncology clinic, we examined the prospectively collected modified Edmonton Symptom Assessment Scale (ESAS‐r) data to explore symptom clusters. Our clinic established use of a modified Edmonton Symptom Assessment Scale in August 2015. All outpatients presenting for radiation oncology services completed the form at each clinic visit. Symptom clusters are defined by two or more symptoms that are interrelated and occur simultaneously with a high degree of predictability. A sample of 916 de‐identified surveys was assessed statistically using principal component analysis (PCA) with varimax rotation to determine independent clustering between the symptoms queried. We found four major clusters of symptoms: Tiredness (tired, drowsiness; PC1), Loss of Appetite (nausea, lack of appetite; PC2), Low Well‐Being (overall & spiritual well‐being; PC3), and Depression (depression, anxiety; PC4). These accounted for 46%, 9.2%, 7.6%, and 7% of total variance, respectively. Internal consistency using Cronbach's alpha was 0.87, 0.7, 0.82, and 0.87, respectively. The most frequent write‐in item was itchiness, present in 24% of the 148 patients responding. Assessment of patients seen in a large radiation oncology clinic revealed several symptom clusters. {Tiredness and drowsiness} represents a major symptom cluster. Itchiness may be underrecognized.

Relationship of Cannabis Use to Patient-Reported Symptoms in Cancer Patients Seeking Supportive/Palliative Care

“…Symptoms were assessed through the patients' self-report on an expanded Edmonton Symptom Assessment Scale-Revised (ESAS-r-css), [7][8][9] a well-validated, brief measure of common symptoms in patients with cancer. Item level scores were documented in the EHR at the initial SCM clinic visit.…”

Update on the Implementation of NCCN Guidelines for Distress Management by NCCN Member Institutions

“…Interestingly, no respondents indicated use of the ESAS for distress screening, although its large-scale use in the clinic-based collection of patient-reported outcomes in a manner similar to distress screening has been documented by at least one MI. 11,12 The relatively widespread use of the Patient Health Questionnaire and Generalized Anxiety Disorder Assessment scales among respondents seems indicative of the persistent focus on psychological indicators of distress. Their use may also reflect cancer centers' efforts to adhere to ASCO's recommendations for the screening, assessment, and treatment of adult patients with cancer who have symptoms of depression and anxiety.…”

Artificial neural networks for simultaneously predicting the risk of multiple co‐occurring symptoms among patients with cancer

“…Unfortunately, this approach fails to account for the possibly strong correlation in symptom burden measures taken from the same patient. 8 Moreover, the relationship between patient-level predictors and symptom burden may be nonlinear and complex, making it difficult to explicitly capture using traditional regression techniques.…”

“…When several symptoms for each patient are being considered, each symptom is often examined separately meaning that an independent regression model is developed for each symptom. Unfortunately, this approach fails to account for the possibly strong correlation in symptom burden measures taken from the same patient 8 . Moreover, the relationship between patient‐level predictors and symptom burden may be nonlinear and complex, making it difficult to explicitly capture using traditional regression techniques.…”