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Screening for clinical insomnia in cancer patients with the Edmonton Symptom Assessment System-Revised: a specific sleep item is needed

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Abstract

Objective

We previously investigated the capacity of the original version of the Edmonton Symptom Assessment System-Revised (ESAS-r) and the Canadian Problem Checklist (CPP) to screen for clinical levels of insomnia in cancer patients. The original ESAS-r includes an item assessing drowsiness and an “other symptom” item, both of which are rated on a scale from 0 to 10, while the CPC has a sleep item, a box which is checked when this problem is present. Because none of these items showed an optimal screening capacity, we concluded that it would be best to add a specific 0–10 sleep item to the ESAS-r. This study assessed the capacity of this ESAS-r-sleep item to screen for clinical insomnia in patients with various cancer types.

Methods

A total of 392 patients with mixed cancer sites completed the ESAS-r as part of a routine screening procedure implemented in the radio-oncology department of L’Hôtel-Dieu de Québec (CHU de Québec-Université Laval). They also filled out the Insomnia Severity Index (ISI).

Results

Using a score of 8 or greater on the ISI as the standard criterion for clinical insomnia, a score of 2 or higher on the ESAS-r-sleep item (50.8% of the patients) was the one that showed the best screening indices: sensitivity of 86.7%, specificity of 75.3%, positive predictive value of 71.9%, and negative predictive value of 88.6%. An area under the curve of 0.89 was found, which is excellent.

Conclusions

Adding a sleep item to the ESAS significantly improves screening of clinical insomnia in cancer patients.

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Notes

  1. We are indebted to Dr. Barry Bultz for suggesting that we make this comparison.

  2. We are indebted to Dr. Cheryl Nekolaichuk for suggesting this.

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Authors and Affiliations

  1. School of Psychology, Université Laval, Québec, Canada

    Josée Savard & Hans Ivers

  2. CHU de Québec-Université Laval Research Center, Québec, Canada

    Josée Savard & Hans Ivers

  3. Université Laval Cancer Research Center, Québec, Canada

    Josée Savard & Hans Ivers

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  1. Josée Savard
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Correspondence to Josée Savard.

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Savard, J., Ivers, H. Screening for clinical insomnia in cancer patients with the Edmonton Symptom Assessment System-Revised: a specific sleep item is needed. Support Care Cancer 27, 3777–3783 (2019). https://doi.org/10.1007/s00520-019-4662-2

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