A Single Set of Numerical Cutpoints to Define Moderate and Severe Symptoms for the Edmonton Symptom Assessment System

Abstract

Symptom intensity in cancer and palliative care patients is frequently assessed using a 0-10 ranking score. Results are then often grouped into verbal categories (mild, moderate, or severe) to guide therapy. Numerical cutpoints separating these categories are often variable, with previous work suggesting different cutpoints across different symptoms, which is unwieldy for clinical use. The Edmonton Symptom Assessment Symptom (ESAS) assesses nine common symptoms using this 0-10 scale. The primary aim of this study was to examine the relationship between the numerical and verbal scores using the ESAS and to identify a single cutpoint to separate severe from nonsevere symptomatology. A second goal was to similarly identify a cutpoint to separate moderate or severe from none or mild symptom intensity. Consenting patients (n=400) completed both a standard ESAS and an identical form that replaced 0-10 with none, mild, moderate, and severe. Receiver operating characteristic curves were generated to identify the best fit between sensitivity and specificity. For the "severe" ranking, six symptoms had a best fit of 7, with sensitivity for the remaining three symptoms still greater than 80%. For the combined grouping of moderate or severe, results were less uniform. A cutpoint of either 4 or 5 would be supported by our data, with a greater sensitivity using 4 and improved specificity using 5 as the cutpoint. Across all ESAS symptoms, then, 7 or higher represents a severe symptom by patient definition, whereas a cutpoint of either 4 or 5 could reasonably define combined moderate and severe symptoms.

Symptom burden and performance status in a population‐based cohort of ambulatory cancer patients

“…On the basis of previous research, individual symptom scores were dichotomized into scores of 0-3 (none to mild) versus 4 (moderate to severe). 19,25 We reran the models and compared our results using a cutoff of 7 (severe). Modeling results were similar with either cutpoint.…”

“…[16][17][18] Previous research has categorized the severity of ESAS scores as none (0), mild (1-3), moderate (4)(5)(6), and severe (7)(8)(9)(10). 19 These scores were reported by the patient at the time of their visit to a cancer center or at the time of a visit from a home-care nurse.…”

Do High Symptom Scores Trigger Clinical Actions? An Audit After Implementing Electronic Symptom Screening

“…17 Following methods used in prior research, the ESAS symptoms were categorized into four categories of severity: none (0 score), mild (1 to 3 score), moderate (4 to 6 score) and severe (7-10 score), where scores of Ͼ 4 indicate clinically significant symptom issues. 24,25 To ensure adequate sample size in each of the ESAS categories by cancer type and symptom, we chose a stratified sampling method. A priori, we aimed for approximately 110 lung and breast cancer visits, respectively, within each of the ESAS score categories (ie, scores ϭ 0, 1-3, 4-6, and 7-10); within each ESAS score category, we aimed for half of the scores to represent pain and half shortness of breath.…”

Symptoms in advanced pancreatic cancer are of importance for energy intake

“…The usual 0-10 numerical rating scales is used where 0 is no symptom and 10 is worst possible symptom. A score of 4 or higher was identified as moderate to severe intensity [24]. The QLQ-PAN26 includes 26 items covering symptoms related to PC and its treatment (pancreatic pain, dietary changes, altered bowel habits, indigestion, flatulence, oral dryness, taste changes, cachexia and jaundice) as well as emotional problems (body image, fear of future health, healthcare satisfaction and sexuality) [23].…”