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

Boonyathee, Sorawit; Nagaviroj, Kittiphon; Anothaisintawee, Thunyarat

doi:10.1177/1049909117745292

Cited by 11 publications

(5 citation statements)

References 22 publications

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“…The ESAS-D cutoff that best balanced specificity and sensitivity for this purpose was ≥2. This result contrasts with a systematic review and meta-analysis, which concluded that an ESAS-D cutoff score of ≥4 is best for detecting depression (sensitivity 53% [95% CI: 38%-67%] and specificity 90% [95% CI: 82%-94%]) (Boonyathee et al 2018). This discrepancy may be due to the possibility that the best cutoff may be population specific.…”

Section: Discussionmentioning

confidence: 57%

“…This provides further support for the need to replicate the current findings in other populations, including individuals who live in different countries. Third, although the power analysis conducted indicated that a sample size of 49 would be adequate for estimating the sensitivity and specificity of the ESAS-D item in the current study, this sample size is lower than that used by many other studies in this area, which have sample sizes that can range from 146 to as many as 969 (Boonyathee et al 2018). Another limitation pertains to the relatively high dropout rate, which was largely due to functional decline stemming from natural prognosis of cancer, which prevented full adherence to the protocol.…”

Section: Limitationsmentioning

confidence: 76%

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The validity of the Edmonton Symptom Assessment System–Depression item for screening for depression in individuals with cancer pain: A cross-sectional study

Wangnamthip,

Benjangkhaprasert,

Tip-Apakoon

et al. 2023

Pall Supp Care

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Context Depression is common in individuals with cancer and pain, negatively impacts quality of life, treatment adherence, tumor progression, and survival. Objectives The primary aims of this study were to (1) evaluate the validity of the Edmonton Symptom Assessment System’s depression (ESAS-D) for detecting major depressive disorder (MDD) as diagnosed by a psychiatrist and (2) identify the best cutoff for this purpose in a sample of cancer pain individuals. The secondary aim was to compare ESAS-D with another commonly used screening measure (Patient Health Questionnaire-2 [PHQ-2]) for classifying individuals as meeting or not meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for depression. Methods 49 cancer pain individuals completed the ESAS-D and PHQ-2 Within 2 weeks, a psychiatrist interviewed the participants and determined whether or not they met criteria for MDD based on the DSM-5. Results The ESAS-D demonstrated acceptable accuracy and validity for classifying MDD. A cutoff of ≥2 was identified as being best able to balance sensitivity (85%) and specificity (76%) and had an overall accuracy of 79%. A receiver operating characteristic curve analysis showed an area under the curve (AUC) of 0.81 (95% confidence interval [CI]: 0.68–0.94). The ESAS-D also compared favorably with the modified Thai PHQ-2 (sensitivity, 75%; specificity, 72%; overall accuracy, 73%; AUC, 0.74 [95% CI: 0.59–0.88]) for identifying MDD individuals. Conclusions The ESAS-D showed acceptable sensitivity, specificity, and overall accuracy for screening for MDD in cancer and pain. It could therefore be used to screen for probable depression in this population.

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Section: Discussionmentioning

confidence: 57%

Section: Limitationsmentioning

confidence: 76%

The validity of the Edmonton Symptom Assessment System–Depression item for screening for depression in individuals with cancer pain: A cross-sectional study

Wangnamthip,

Benjangkhaprasert,

Tip-Apakoon

et al. 2023

Pall Supp Care

View full text Add to dashboard Cite

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“…This same cut-off level has also been shown to be useful in detecting clinical depression defined by standardized questionnaires among patients with cancer. 30 According to the logistic regression analysis, the relation between ESAS depression scores is not affected by subjects’ characteristics or other ESAS items. Based on the current results, we suggest that in patients scoring 0 on the ESAS depression question, there is probably no need for further evaluation of depression.…”

Section: Discussionmentioning

confidence: 99%

Assessing Symptom Burden and Depression in Subjects With Chronic Respiratory Insufficiency

et al. 2021

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Objectives: Patients with chronic respiratory insufficiency suffer from advanced disease, but their overall symptom burden is poorly described. We evaluated the symptoms and screening of depression in subjects with chronic respiratory insufficiency by using the Edmonton symptom assessment system (ESAS). Methods: In this retrospective study, 226 subjects with chronic respiratory insufficiency answered the ESAS questionnaire measuring symptoms on a scale from 0 (no symptoms) to 10 (worst possible symptom), and the depression scale (DEPS) questionnaire, in which the cut-off point for depressive symptoms is 9. Results: The most severe symptoms measured with ESAS (median [interquartile range]) were shortness of breath 4.0 (1.0-7.0), dry mouth 3.0 (1.0-7.0), tiredness 3.0 (1.0-6.0), and pain on movement 3.0 (0.0-6.0). Subjects with a chronic obstructive pulmonary disease as a cause for chronic respiratory insufficiency had significantly higher scores for shortness of breath, dry mouth, and loss of appetite compared to others. Subjects with DEPS ≥9 reported significantly higher symptom scores in all ESAS categories than subjects with DEPS <9. The area under the receiver operating characteristic curve for ESAS depression score predicting DEPS ≥9 was 0.840 ( P < .001). If the ESAS depression score was 0, there was an 89% probability of the DEPS being <9, and if the ESAS depression score was ≥4, there was an 89% probability of the DEPS being ≥9. The relation between ESAS depression score and DEPS was independent of subjects’ characteristics and other ESAS items. Conclusions: Subjects with chronic respiratory insufficiency suffer from a high symptom burden due to their advanced disease. The severity of symptoms increases with depression and 4 or more points in the depression question of ESAS should lead to a closer diagnostic evaluation of depression. Symptom-centered palliative care including psychosocial aspects should be early integrated into the treatment of respiratory insufficiency.

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“…The responses on the ESAS (0 = absent to 10 = extremely severe) for each symptom were grouped into four categories according to the responses: absent (0), mild (1, 2, 3), moderate (4, 5, 6), and severe (7, 8, 9, 10) [ 21 ]. We compared symptom severity between the curative intent group and the palliative intent group (curative intent group treatment aimed to achieve complete remission and prevent a recurrence, while the palliative intent group focused on no cure but simply decreasing tumor burden and prolonging life expectancy) [ 22 ] by Chi-Square tests.…”

Section: Methodsmentioning

confidence: 99%

Care Needs and Symptoms Burden of Breast Cancer Patients in Jordan: A Cross-Sectional Study

Shamieh

Alarjeh

et al. 2022

IJERPH

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Breast cancer is the most common malignancy in Jordan. Rigorous needs assessment for breast cancer patients can prioritize both cancer care and palliative care to propose the appropriate services effectively. We conducted a cross-sectional study of breast cancer patients in a cancer center in Jordan. We assessed symptom burden, comorbidities, and performance using the Edmonton Symptom Assessment System (ESAS), the Charlson Comorbidity Index (CCI), and the Australia-modified Karnofsky performance scale (AKPS). Descriptive analysis and regression models to predict the highest symptom burden were used. A total of 233 participants were enrolled: curative vs. palliative intent groups (147 (63%) vs. 86 (37%) patients), respectively. Tiredness was the most reported symptom in 189 patients (81%), while nausea was the least in 61 patients (26.2%). A relationship between the AKPS score and total ESAS was seen (correlation coefficient of −0.487; p < 0.0001). The prevalence of anxiety (p = 0.014), lack of appetite (p = 0.002), poor well-being (p < 0.001), and sleep disorder (p = 0.035) was higher in the palliative care intent group than in the curative one. We identified unmet needs in breast cancer patients. Both groups showed a prevalence of distressing symptoms suggesting that even those with non-palliative intent have high needs and should receive integrated palliative care.

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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

Cited by 11 publications

References 22 publications

The validity of the Edmonton Symptom Assessment System–Depression item for screening for depression in individuals with cancer pain: A cross-sectional study

The validity of the Edmonton Symptom Assessment System–Depression item for screening for depression in individuals with cancer pain: A cross-sectional study

Assessing Symptom Burden and Depression in Subjects With Chronic Respiratory Insufficiency

Care Needs and Symptoms Burden of Breast Cancer Patients in Jordan: A Cross-Sectional Study

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