The Edmonton Symptom Assessment System: Poor performance as screener for major depression in patients with incurable cancer

Brenne, Elisabeth; Loge, Jon Håvard; Lie, Hanne C.; Hjermstad, Marianne Jensen; Fayers, Peter; Kaasa, Stein

doi:10.1177/0269216315620082

Cited by 11 publications

(14 citation statements)

References 74 publications

(152 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Area Under the Curve (AUC) provides an estimate of overall discrimination for evaluations of possible adequate cut off values of the ESAS. AUC of 0.5-0.7 indicates low accuracy, 0.7-0.9 indicates moderate accuracy and 0.9-1.0 indicates high accuracy [41]. The Youden index (J) was computed to find a cut-point that maximizes the variable's differentiating ability from the ROC curves.…”

Section: Discussionmentioning

confidence: 99%

“…The DCPR has been extensively used in medical settings and it enables clinicians to identify psychosocial conditions to a much greater extent than the DSM or ICD classification by providing information on specific psychological and psychosocial factors affecting a prevalent number of patients suffering from a given group of medical illnesses [40]. Following other authors' recommendations, [6,41] we considered those patients who resulted positive to one or more DCPR diagnosis as "cases", for the purpose of this study.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients

Battaglia

Zerbinati

Piazza

et al. 2020

JCM

View full text Add to dashboard Cite

An average prevalence of 35% for psychiatric comorbidity has been reported in kidney transplant recipients (KTRs) and an even higher prevalence of other psychosocial syndromes, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), has also been found in this population. Consequently, an easy, simple, rapid psychiatric tool is needed to measure physical and psychological symptoms of distress in KTRs. Recently, the Edmonton Symptom Assessment System (ESAS), a pragmatic patient-centred symptom assessment tool, was validated in a single cohort of KTRs. The aims of this study were: to test the screening performances of ESAS for the International Classification of Diseases-10th Revision (ICD-10) psychiatric diagnoses in KTRs; to investigate the optimal cut-off points for ESAS physical, psychological and global subscales in detecting ICD-10 psychiatric diagnoses; and to compare ESAS scores among KTR with ICD-10 diagnosis and DCPR diagnosis. 134 KTRs were evaluated and administered the MINI International Neuropsychiatric Interview 6.0 and the DCPR Interview. The ESAS and Canadian Problem Checklist (CPC) were given as self-report instruments to be filled in and were used to examine the severity of physical and psychological symptoms and daily-life problems. The physical distress sub-score (ESAS-PHYS), psychological distress sub-score (ESAS-PSY) and global distress score (ESAS-TOT) were obtained by summing up scores of six physical symptoms, four psychological symptoms and all single ESAS symptoms, respectively. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. Receiving Operating Characteristic (ROC) analysis was used to examine the ability of the ESAS emotional distress (DT) item, ESAS-TOT, ESAS-PSY and ESAS-PHYS, to detect psychiatric cases defined by using MINI6.0. The area under the ROC curve for ESAS-TOT, ESAS-PHYS, ESAS-PSY and DT item were 0.85, 0.73, 0.89, and 0.77, respectively. The DT item, ESAS-TOT and ESAS-PSY optimal cut-off points were ≥4 (sensitivity 0.74, specificity 0.73), ≥20 (sensitivity 0.85, specificity 0.74) and ≥12 (sensitivity 0.85, specificity 0.80), respectively. No valid ESAS-PHYS cut-off was found (sensitivity <0.7, specificity <0.7). Thirty-nine (84.8%) KTRs with ICD-10 diagnosis did exceed both ESAS-TOT and ESAS-PSY cut-offs. Higher scores on the ESAS symptoms (except shortness of breath and lack of appetite) and on the CPC problems were found for ICD-10 cases and DCRP cases than for ICD-10 no-cases and DCPR no-cases. This study shows that ESAS had an optimal screening performance (84.8%) to identify ICD-10 psychiatric diagnosis, evaluated with MINI; furthermore, ESAS-TOT and ESAS-PSY cut-off points could provide a guide for clinical symptom management in KTRs.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients

Battaglia

Zerbinati

Piazza

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…In our data, Cronbach's alpha was 0.87. There is an ongoing debate in the literature about this point with proponents and opponents of the tool . Nevertheless, the ESAS can be used as a screening tool for a mood disorder; patients endorsing high levels of these symptoms should be referred to psychosocial services for a more thorough evaluation and appropriate intervention.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

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.

show abstract

“…The second cutoff value was ESAS-D ! 4, which showed a pooled sensitivity of 0.53 (95% CI: 0.38-0.67), a pooled specificity of 0.9 (95% CI: 0.82-0.94), a positive likelihood ratio of 5.2 (95% CI: 3.1-8.6), a diagnostic odds ratio of 10 (95% CI: [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], and an area under the ROC curve of 0.82 (95% CI: 0.79-0.85). Despite having lower sensitivity, an ESAS-D !…”

Section: Discussionmentioning

confidence: 99%

“…Some previous studies have examined the diagnostic performance of the ESAS-D for depression and have proposed cutoff values varying from 2 to 4. [10][11][12][13][14] However, there has been no definite conclusion as to what would be the optimal cutoff value in order to determine depression among patients with cancer.…”

Section: Introductionmentioning

confidence: 99%

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

Boonyathee

Nagaviroj

Anothaisintawee

2017

Am J Hosp Palliat Care

View full text Add to dashboard Cite

show abstract

The Edmonton Symptom Assessment System: Poor performance as screener for major depression in patients with incurable cancer

Abstract: Background: Depressive symptoms are prevalent in patients with advanced cancer,

Cited by 11 publications

References 74 publications

Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients

Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients

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

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

Contact Info

Product

Resources

About