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The Edmonton Symptom Assessment System (ESAS) as a screening tool for depression and anxiety in non-advanced patients with solid or haematological malignancies on cure or follow-up

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Abstract

Background

Symptoms’ assessment should be considered a clinical practice routine in all cancer stages. The Edmonton Symptom Assessment System (ESAS) is a ten-item patient-rated symptom assessment developed and validated for population affected by cancer in different languages and cultures. The main objective of this study was to assess the performance of ESAS items on anxiety and depression when detecting Hospital Anxiety Depression Scale (HADS) ‘cases’.

Methods

A cross-sectional study was carried out on 194 non-advanced patients with solid (108) or hematologic malignancies on cure or follow up, Karnofsky Performance Status ≥ 70, life expectancy > 6 months and no metastases. Patients were assessed by means of ESAS and by HADS. Receiving operator characteristic (ROC) analysis of ESAS anxiety and depression items versus cases of severe (cutoff 11) anxiety and depression according to HADS-specific subscales was performed.

Results

Depression and anxiety ESAS items correlated strongly (0.707, Spearman). Area under the curve ranged between 0.84 and 0.96 for the two ESAS items when detecting severe anxiety or depression HADS cases (cutoff = 11). ESAS anxiety or depression scores >3 detected quite well the severe depression HADS cases (Sensibility = 75–Specificity = 84, Sensibility = 87–Specificity = 90, respectively).

Conclusions

Anxiety or depression ESAS items score >3 can be applied as a useful, easy and not time consuming screening tool for assessing anxiety and depression in non-advanced patients with solid or haematological malignancies.

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References

  1. Jacobsen PB, Shibata D, Siegel EM et al (2011) Evaluating the quality of psychosocial care in outpatient medical oncology settings using performance indicators. Psychooncology 20/11:1221–1227

    Article  Google Scholar 

  2. Ripamonti CI, Santini D, Maranzano E, Berti M, Roila F (2012) Management of cancer pain: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(suppl 7):vii139–vii154

    Article  PubMed  Google Scholar 

  3. Holland JC, Alici Y (2010) Management of distress in cancer patients. J Support Oncol 8:4–12

    PubMed  Google Scholar 

  4. Rhondali W, Perceau E, Saltel P, Trillet-Lenoir V, Blay J-V, Fournel-Federico C et al (2012) Depression assessment by oncologist and palliative care physicians. Palliat Support Care 10:255–263

    Article  Google Scholar 

  5. NCCN Clinical Practice Guidelines in Oncology- Distress Management, V.2.2010. June 2010. National Comprehensive Cancer Network (NCCN). (http://www.nccn.org/professionals/physician_gls/f_guidelines.asp) assessed 26 November 2010

  6. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 12:160–174

    Article  PubMed  Google Scholar 

  7. Stiefel R, Die Trill M, Berney A et al (2001) Depression in palliative care: a pragmatic report from the expert working group of the European association for palliative care. Support Care Cancer 9:477–488

    Article  CAS  PubMed  Google Scholar 

  8. Rayner L, Price A, Hotopf M et al (2011) The development of evidence-based European guidelines on the management of depression in palliative cancer care. Eur J Cancer 47:702–712

    Article  PubMed  Google Scholar 

  9. Mitchell AJ, Kaar S, Coggan C, Herdman J (2008) Acceptability of common screening methods used to detect distress and related mood disorders-preferences of cancer specialists and non- specialists. Psychooncology 17:226–236

    Article  PubMed  Google Scholar 

  10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th ED. Washington: American Psychiatric Press 1994

  11. Rodin G, Lloyd N, Katz M, Green E, Mackay JA, Wong RK (2007) The treatment of depression in cancer patients: a systematic review. Support Care Cancer 15:123–136

    Article  PubMed  Google Scholar 

  12. Passik SD, Dugan W, McDonald MV, Rosenfeld B, Theobald DE, Edgerton S (1998) Oncologists’ recognition of depression in their patients with cancer. J Clin Oncol 16:1594–1600

    CAS  PubMed  Google Scholar 

  13. Fallowfield L, Ratcliffe D, Jenkins V, Saul J (2001) Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer 84:1011–1015

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Sharpe M, Strong V, Allen K et al (2004) Major depression in outpatients attending a regional cancer center. Screening, prevalence and unmet treatment needs. Br J Cancer 90:314–320

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Morselli M, Bandieri E, Zanin R et al (2010) Pain and emotional distress in leukemia patients at diagnosis. Leuk Res 34(2):e67–e68

    Article  PubMed  Google Scholar 

  16. Rhondali W, Perceau E, Berthiller J, Saltel P, Trillet-Lenoir V, Tredan O, Coulon J-P, Bruera E, Filbert M (2012) Frequency of depression among oncology outpatients and association with other symptoms. Support Care Cancer 20:2795–2802

    Article  PubMed  Google Scholar 

  17. Bruera E, Kuehn N, Miller M et al (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9

    CAS  PubMed  Google Scholar 

  18. Moro C, Brunelli C, Miccinesi G, Fallai M, Morino P, Piazza M, Labianca R, Ripamonti C (2006) Edmonton Symptom Assessment Scale (ESAS): Italian validation in two palliative care settings. Support Care Cancer 14:30–37

    Article  PubMed  Google Scholar 

  19. Carvajal A, Centeno C, Watson R, Bruera E (2011) A Comprehensive study of psychometric properties of the Edmonton Symptom Assessment System (ESAS) in Spanish advanced cancer patients. Eur J Cancer 47:1863–1872

    Article  PubMed  Google Scholar 

  20. Pautex S, Berger A, Catelain C, Hermann F, Zulian G (2003) Symptom assessment in elderly cancer patients receiving palliative care. Crit Rev Oncol Haematol 47:281–286

    Article  Google Scholar 

  21. Stiel S, Matthes ME, Bertram L et al (2010) Validation of the new version of the minimal documentation system (MIDOS) for patients in palliative care: the German version of the Edmonton Symptom Assessment Scale (ESAS). Schmerz 24/6:596–604

    Article  Google Scholar 

  22. Jaturapatporn D (2008) Validity and cross-culture adaptation of the Thai version of the Edmonton Symptom Assessment Scale (ESAS). Palliat Med 22:448

    Article  Google Scholar 

  23. Cummings G, Biondo BD, Campbell D, Stiles C, Fainsinger R, Muise M, Hagen N (2011) Can the global uptake of palliative care innovations be improved? Insights from a bibliometric analysis of the Edmonton Symptom Assessment System. Palliat Med 25/1:71–82

    Article  Google Scholar 

  24. Chang VT, Hwang SS, Feuerman M (2000) Validation of the Edmonton Symptom Assessment Scale. Cancer 88:2164–2171

    Article  CAS  PubMed  Google Scholar 

  25. Dudgeon D, King S, Howell D et al (2012) Cancer Care Ontario’s experience with implementation of routine physical and psychological symptom distress screening. Psycho Oncol 21:357–364

    Article  Google Scholar 

  26. Bultz BD Final report: screening for distress, the 6th vital sign, A driver for person centered care: screening for distress Working Group of the Cancer Journey Action Group (ed), Canadian Partnership Against Cancer, Calgary, AB, 10-10-2010,14

  27. Republic of Italy: DL 15 marzo 2010,n.38 Disposizioni per garantire l’accesso alle cure palliative e alla terapia del dolore. Gazzetta Ufficiale, Serie Generale no. 65; 19/03/2010

  28. Ripamonti CI, Buonaccorso L, Maruelli A, Bandieri E, Boldini S, Pessi MA, Chiesi F, Miccinesi G (2012) Hope Herth Index (HHI): the validation study in Italian patients with solid and haematological malignancies on active oncological therapies. Tumori 98:385–392

    PubMed  Google Scholar 

  29. Ripamonti CI, Buonaccorso L, Maruelli A, Bandieri E, Pessi MA, Boldini S, Primi C, Miccinesi G (2012) Patient Dignity Inventory (PDI) questionnaire: the validation study in Italian patients with solid and haematological cancers on active oncological treatments. Tumori 98(4):491–500

    PubMed  Google Scholar 

  30. Ripamonti CI, Pessi MA, Maruelli A, Boldini S, Miccinesi G, Bandieri E, Buonaccorso L (2012) Physical and emotional symptoms in patients with solid and haematologic malignancies without metastases, on cure or follow-up: are they overlapping? POSTER PRESENTATION MASCC/ISOO 2012. Support Care Cancer 20(Suppl 1):58–275

    Google Scholar 

  31. Maruelli A, Ripamonti C, Bandieri E, Boldini S, Miccinesi G, Pessi MA, Buonaccorso L (2012) About sexuality of 194 non metastatic cancer patients on cure or follow-up". POSTER PRESENTATION MASCC/ISOO. Support Care Cancer 20/1:58–411

    Google Scholar 

  32. Ripamonti CI, Boldini S, Buonaccorso A, Bandieri E, Maruelli A, Pessi MA, Miccinesi G (2012) Edmonton Symptom Assessment Scale (ESAS) for routine symptom assessment of non-advanced patients with solid or haematological malignancies on oncological therapies. POSTER PRESENTATION MASCC/ISOO 2012. Support Care Cancer 20(Suppl 1):58–263

    Google Scholar 

  33. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  CAS  PubMed  Google Scholar 

  34. Costantini M, Musso M, Viterboni P, Bonci F, Del Mastro L, Garrone O, Venturini M, Marasso G (1999) Detecting psychological distress in cancer patients: validity of the Italian version of the hospital anxiety and depression scale. Support Care Cancer 7:121–127

    Article  CAS  PubMed  Google Scholar 

  35. Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res 52(2):69–77

    Article  PubMed  Google Scholar 

  36. Vignaroli E, Pace EA, Willey J, Palmer JL, Zhang T, Bruera E (2006) The Edmonton symptom assessment system as a screening tool for depression and anxiety. J Palliat Med 9/2:296–303

    Article  Google Scholar 

  37. Bagha SM, Macedo A, Jacks LM, Zimmermann C, Rodin G (2012) The utility of the Edmonton Symptom Assessment System in screening for anxiety and depression. Eur J Cancer Care. doi:10.1111/j.1365-2354.2012.01369.x

    Google Scholar 

  38. Ventafridda V, De Conno F, Ripamonti C, Gamba A, Tamburini M (1990) Quality of life assessment during a palliative care programme. Ann Oncol 1:415–420

    CAS  PubMed  Google Scholar 

  39. Bergh I, Kvalem IL, Aass N, Hjermstad MJ (2011) What does the answer mean? A qualitative study of how palliative cancer patients interpret and respond to the Edmonton Symptom Assessment System. Palliat Med 25/7:716–724

    Article  Google Scholar 

  40. Noguera A, Centeno C, Carvajal A, Portela Tejedor MA, Urdiroz J, Martinez M (2009) Spanish “Fine Tuning” of language to describe depression and anxiety. J Palliat Med 12/8:707–712

    Article  Google Scholar 

  41. Pinquart M, Duberstein PR (2010) Depression and cancer mortality: a meta-analysis. Psychol Med 40:1–14

    Article  Google Scholar 

  42. Emanuel EJ, Fairclough DL, Daniels ER, Clarridge BR (1996) Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public. Lancet 347:1805–1810

    Article  CAS  PubMed  Google Scholar 

  43. Wilson KG, Scott JF, Graham ID et al (2000) Attitudes of terminally ill patients toward euthanasia and physician-assisted suicide. Arch Intern Med 160:2454–2460

    Article  CAS  PubMed  Google Scholar 

  44. Breitbart W, Rosenfeld B, Pessin H et al (2000) Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 284:2907–2911

    Article  CAS  PubMed  Google Scholar 

  45. Tiernan E, Casey P, O’Boyle C, Birkbeck G, Mangan M, O’Siorain L, Kearney M (2002) Relations between desire for early death, depressive symptoms and antidepressant prescribing in terminally ill patients with cancer. J R Soc Med 95(8):386–390

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  46. Chochinov HM, Wilson K, Enns M et al (1995) Desire for death in the terminally ill. Am J Psychiatry 152:1185–1191

    CAS  PubMed  Google Scholar 

  47. Juliao M, Barboa A, Oliveira F, Nunes B (2013) Prevalence and factors associated with desire for death in patients with advanced disease: results from a Portuguese cross-sectional study. Psychosomatics 54(5):451–457

    Google Scholar 

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Acknowledgments

We thank Martina Ferrari, B.Sc. University of Chester, England for the support in reviewing the English language

Conflict of interest

I declare that we have no financial relationship with anyone.

No organization sponsored the research; the authors have no conflict of interest.

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Authors and Affiliations

  1. Department of Hematology and Pediatric Onco-Hematology, Supportive Care in Cancer Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy

    Carla I. Ripamonti & Maria Adelaide Pessi

  2. Oncological Unit, Azienda Usl Modena (CeVEAS), Modena, Italy

    Elena Bandieri

  3. Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy

    Alice Maruelli

  4. AMO, Association of Oncological Patients from nine towns and villages located in the Northern area of Modena, Modena, Italy

    Loredana Buonaccorso

  5. Clinical Epidemiology Unit, ISPO-Institute for the Study and Prevention of Cancer, Florence, Italy

    Guido Miccinesi

Authors
  1. Carla I. Ripamonti
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Corresponding author

Correspondence to Carla I. Ripamonti.

Appendix

Appendix

Table 6 Italian version of ESAS
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Ripamonti, C.I., Bandieri, E., Pessi, M.A. et al. The Edmonton Symptom Assessment System (ESAS) as a screening tool for depression and anxiety in non-advanced patients with solid or haematological malignancies on cure or follow-up. Support Care Cancer 22, 783–793 (2014). https://doi.org/10.1007/s00520-013-2034-x

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