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

Supportive Care in Cancer volume 27, pages 3777–3783 (2019)Cite this article

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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Fig. 1

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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Author information

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

Authors
  1. Josée Savard
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  2. Hans Ivers
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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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  • DOI: https://doi.org/10.1007/s00520-019-4662-2

Keywords

  • Insomnia
  • Sleep
  • Screening
  • Tiredness
  • Fatigue
  • Cancer
  • ROC