A Multicenter Study Comparing Two Numerical Versions of the Edmonton Symptom Assessment System in Palliative Care Patients

Watanabe, Sharon; Nekolaichuk, Cheryl; Beaumont, Crystal; Johnson, Laureen; Myers, Jeff; Strasser, Florian

doi:10.1016/j.jpainsymman.2010.04.020

Cited by 305 publications

(240 citation statements)

References 25 publications

(25 reference statements)

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“…To address some of the issues associated with the tool itself, our research group has undertaken a series of studies to review the current status of the ESAS, identify problematic areas associated with its use in clinical practice and develop a revised version, the ESAS-r [12,14,20,31]. This revised version was based on a patient "think aloud" study, in which 20 patients were asked to provide their clinical reasoning regarding the ratings they selected while completing the ESAS, as well as their personal opinions regarding the tool [20].…”

Section: Discussionmentioning

confidence: 99%

“…This revised version was based on a patient "think aloud" study, in which 20 patients were asked to provide their clinical reasoning regarding the ratings they selected while completing the ESAS, as well as their personal opinions regarding the tool [20]. A comparison study of the original ESAS and the ESAS-r, involving 160 patients, provided additional support for the proposed changes [31]. However, these changes were based on patient input only.…”

Section: Discussionmentioning

confidence: 99%

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Health care providers’ use and knowledge of the Edmonton Symptom Assessment System (ESAS): is there a need to improve information and training?

Buttenschoen

Stephan²,

Watanabe

et al. 2013

Support Care Cancer

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Objectives The ESAS is a clinical symptom assessment tool developed for patients receiving palliative care for pain and symptom control. Recent studies have indicated that patients have difficulty understanding terminology and correct use of the ESAS, and that they appreciate the presence of a health care provider (HCP) to assist with ESAS completion. As appropriate assessment translates into effective treatment, it is important that HCPs have a good understanding of the tool. The purpose of this study was to assess HCPs' use, knowledge, and training needs of the ESAS. Methods One hundred ninety-three HCPs in palliative care and chronic pain, who used the ESAS, were invited to participate in a survey. Results The response rate was 43 % (n =83), with 62 % nurses, 26 % physicians, and 12 % other specialties. Most participants were palliative care specialists (79 %). The majority (77 %) had a good understanding of the ESAS terms. Knowledge problems included distinguishing tiredness and drowsiness (25 %), interpreting shortness of breath as a combination of subjective and objective symptoms (19 %), not indicating current symptom level (14 %), and reverse scoring of well-being (13 %) and appetite (9 %). Reported challenges were misinterpretation of some ESAS terms, assessing patients with impaired communication, and lack of time and reliability of caregiver assessments. Participants offered suggestions regarding how their knowledge and use of the ESAS could be improved. Conclusions Suggestions for improving ESAS administration and training were to include term definitions and examples of how to ask about terms that might be challenging for patients. Furthermore, initial and ongoing training sessions might help to clarify issues with the tool.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Health care providers’ use and knowledge of the Edmonton Symptom Assessment System (ESAS): is there a need to improve information and training?

Buttenschoen

Stephan²,

Watanabe

et al. 2013

Support Care Cancer

Self Cite

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“…The ESAS-r assesses these nine symptoms on a numerical scale from 0 (none, best) to 10 (most terrible). Performance status was measured using the PPS version 2 (PPSv2) 14,24 which replaces the original PPS 17 . In the PPSv2, physical performance is measured in 10% decremental levels from completely mobile (100%) to death (0%).…”

Section: Assessment Tools and Data Collectionmentioning

confidence: 99%

“…These levels are determined by five discernible parameters that incorporate ambulation, activity and evidence of disease, self-care, intake and conscious level. The PPSv2 was rated according to the guidelines published by Victoria Hospice Society 14 .…”

Section: Assessment Tools and Data Collectionmentioning

confidence: 99%

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The Relationship between Distressing Symptoms and Performance Status among Cancer Patients Receiving Palliative Care

Hussenein

Hashem

Hadary

et al. 2017

Kasr-Al-Aini J.of Clin. Onc. and Nuc. Med.

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Background:Patients with advanced cancer experience distressing symptoms and progressive decline in their performance status (PS) as death approaches. Aim: To identify the relationship between symptom burden and PS of Egyptian cancer patients receiving palliative care. Methods: This was a prospective observational study that included 100 patients with advanced cancer. Symptom burden was assessed using the Arabic version of the revised Edmonton Symptom Assessment System (ESAS-r). Performance status was assessed using the Palliative Performance Scale (PPS). Results:The mean total ESAS-r score was 60.1 (±10.7). The most common symptom to be reported as severe was pain (93%) followed by tiredness (74%), poor wellbeing (67%), lack of appetite (62%), anxiety (60%) and drowsiness (56%). The majority of patients (76%) had a PPS score ≤30 with an overall mean PPS score of 36.2 (±13.3). There was a statistically significant negative correlation between the total ESAS score and the PPS score (r = -0.687, p = < 0.001). Conclusion:The results suggest that Egyptian patients with advanced cancer experience high symptom burden and significant decline in PS. The higher the symptom burden, the poorer the PS of patients with advanced cancer.

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Patient-Reported Outcomes, Tumor Markers, and Survival Outcomes in Advanced GI Cancer

Jarnagin,

Saraf,

Baiev

et al. 2023

JAMA Netw Open

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ImportancePatient-reported outcomes (PROs), such as quality of life (QOL) and symptoms, are often associated with clinical outcomes in patients with cancer. In practice, oncologists use serum tumor markers (TMs) (ie, carcinoembryonic antigen [CEA] and carbohydrate antigen 19-9 [CA 19-9]) and imaging to monitor clinical outcomes in patients with gastrointestinal cancer.ObjectiveTo examine associations of 1-month changes in PROs and TMs with treatment response and survival among patients with gastrointestinal cancer.Design, Setting, and ParticipantsThis cohort study enrolled patients at Massachusetts General Hospital Cancer Center with at least 1 month follow-up from May 2019 to December 2020. Included patients were beginning first-line systemic therapy, aged 18 years or older, and had been diagnosed with metastatic pancreaticobiliary, colorectal, or gastroesophageal cancer. Data analyses took place from January 2021 to January 2022.InterventionPROs were collected, including QOL (Functional Assessment of Cancer Therapy General [FACT-G]), physical symptoms (Edmonton Symptom Assessment System [ESAS]), and psychological symptoms (Patient Health Questionnaire-4 [PHQ4] total, PHQ4-depression, and PHQ4-anxiety), as well as TMs (CEA and CA 19-9), at the time of chemotherapy initiation and 1 month later.Main Outcomes and MeasuresAssociations of 1-month changes in PROs and TMs with treatment response (clinical benefit vs disease progression) at first scan, progression-free survival (PFS), and overall survival (OS), adjusted for baseline values using regression models.ResultsThis study included 159 patients, with 134 patients (84.3%) evaluable for analysis. Patients had a median (range) age of 64.0 (28.0-84.0) years and 86 (64.2%) were male. One-month PRO changes (FACT-G: OR, 1.07; 95% CI, 1.03-1.11; P = .001; ESAS-total: OR, 0.97; 95% CI, 0.94-1.00; P = .02; ESAS-physical: OR, 0.96; 95% CI, 0.92-1.00; P = .03; PHQ4-depression: OR, 0.67; 95% CI, 0.49-0.92; P = .01) were significantly associated with treatment response, but PHQ4-total or TMs were not. Changes in FACT-G (HR, 0.97; 95% CI, 0.95-0.99; P = .003), ESAS-total (HR, 1.03; 95% CI, 1.01-1.05; P = .004), ESAS-physical (HR, 1.03; 95% CI, 1.00-1.05; P = .02), PHQ4-depression (HR, 1.22; 95% CI, 1.01-1.48; P = .04), and CEA (HR, 1.00; 95% CI, 1.001-1.004; P = .001) were associated with PFS, but changes in PHQ4-total or TMs were not. Changes in ESAS-total (HR, 1.03, 95% CI, 1.01-1.06; P = .006) and ESAS-physical (HR, 1.04, 95% CI, 1.01-1.06; P = .015) were associated with OS, but changes in TMs were not associated with OS.Conclusions and RelevanceThese findings suggest that 1-month changes in PROs can be associated with treatment response and survival in patients with advanced gastrointestinal cancer. Notably, 1-month changes in TMs were not consistently associated with these outcomes. These findings highlight the potential for monitoring early changes in PROs to associate with clinical outcomes while underscoring the need to address the QOL and symptom concerns of patients with advanced cancer.

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A Multicenter Study Comparing Two Numerical Versions of the Edmonton Symptom Assessment System in Palliative Care Patients

Abstract: The ESAS-r retains core elements of the ESAS, with improved interpretation and clarity of symptom intensity assessment. It represents the next generation of ESAS development, with further validation recommended for drowsiness, appetite, and well-being.

Cited by 305 publications

References 25 publications

Health care providers’ use and knowledge of the Edmonton Symptom Assessment System (ESAS): is there a need to improve information and training?

Health care providers’ use and knowledge of the Edmonton Symptom Assessment System (ESAS): is there a need to improve information and training?

The Relationship between Distressing Symptoms and Performance Status among Cancer Patients Receiving Palliative Care

Patient-Reported Outcomes, Tumor Markers, and Survival Outcomes in Advanced GI Cancer

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