Breffni Hannon1, Martin Dyck2, Ashley Pope2, Nadia Swami2, Subrata Banerjee3, Ernie Mak3, John Bryson1, Gary Rodin4, Julia Ridley3, Chris Lo5, Lisa W Le6, Camilla Zimmermann7. 1. Division of Medical Oncology & Haematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology & Palliative Care, Ontario Cancer Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 2. Department of Psychosocial Oncology & Palliative Care, Ontario Cancer Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 3. Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology & Palliative Care, Ontario Cancer Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 4. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology & Palliative Care, Ontario Cancer Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Campbell Family Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 5. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology & Palliative Care, Ontario Cancer Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 6. Department of Biostatistics, Ontario Cancer Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 7. Division of Medical Oncology & Haematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology & Palliative Care, Ontario Cancer Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Campbell Family Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. Electronic address: camilla.zimmermann@uhn.ca.
Abstract
CONTEXT: The Edmonton Symptom Assessment System (ESAS) measures the severity of nine symptoms. Constipation and sleep disturbance are common in patients with cancer, but are not currently included in the ESAS. OBJECTIVES: To validate the numerical rating scale (NRS) versions of ESAS and its revised version (ESAS-r), with the additional symptoms of constipation and sleep (CS), and to assess patient preference for either version. METHODS: Outpatients with advanced cancer (N = 202) completed three assessments during a single clinic visit: ESAS-CS, and an added time window of "past 24 hours"; ESAS-r-CS, with a time window of "now" and symptom definitions; and the Memorial Symptom Assessment Scale (MSAS). Internal consistency was calculated using Cronbach's alpha. Paired t-tests compared ESAS-CS and ESAS-r-CS scores; these were correlated with MSAS using Spearman correlation coefficients. Test-retest reliability at 24 hours was assessed in 26 patients. RESULTS: ESAS-CS and ESAS-r-CS total scores correlated well with total MSAS (Spearman's rho 0.62 and 0.64, respectively). Correlation of individual symptoms with MSAS symptoms ranged from 0.54-0.80 for ESAS-CS and 0.52-0.74 for ESAS-r-CS. Although participants preferred the ESAS-r-CS format (42.8% vs. 18.6%) because of greater clarity and understandability, the "past 24 hours" time window (52.8%) was favored over "now" (21.3%). Shortness of breath and nausea correlated better for the "past 24 hours" time window (0.8 and 0.72 vs. 0.74 and 0.64 in ESAS-r-CS, respectively). The 24-hour test-retest of the ESAS-CS demonstrated acceptable reliability (intraclass correlation coefficient = 0.69). CONCLUSION: The ESAS-CS and ESAS-r-CS NRS versions are valid and reliable for measuring symptoms in this population of outpatients with advanced cancer. Although the ESAS-r-CS was preferred, patients favored the 24-hour time window of the ESAS-CS, which also may best characterize fluctuating symptoms.
CONTEXT: The Edmonton Symptom Assessment System (ESAS) measures the severity of nine symptoms. Constipation and sleep disturbance are common in patients with cancer, but are not currently included in the ESAS. OBJECTIVES: To validate the numerical rating scale (NRS) versions of ESAS and its revised version (ESAS-r), with the additional symptoms of constipation and sleep (CS), and to assess patient preference for either version. METHODS: Outpatients with advanced cancer (N = 202) completed three assessments during a single clinic visit: ESAS-CS, and an added time window of "past 24 hours"; ESAS-r-CS, with a time window of "now" and symptom definitions; and the Memorial Symptom Assessment Scale (MSAS). Internal consistency was calculated using Cronbach's alpha. Paired t-tests compared ESAS-CS and ESAS-r-CS scores; these were correlated with MSAS using Spearman correlation coefficients. Test-retest reliability at 24 hours was assessed in 26 patients. RESULTS:ESAS-CS and ESAS-r-CS total scores correlated well with total MSAS (Spearman's rho 0.62 and 0.64, respectively). Correlation of individual symptoms with MSAS symptoms ranged from 0.54-0.80 for ESAS-CS and 0.52-0.74 for ESAS-r-CS. Although participants preferred the ESAS-r-CS format (42.8% vs. 18.6%) because of greater clarity and understandability, the "past 24 hours" time window (52.8%) was favored over "now" (21.3%). Shortness of breath and nausea correlated better for the "past 24 hours" time window (0.8 and 0.72 vs. 0.74 and 0.64 in ESAS-r-CS, respectively). The 24-hour test-retest of the ESAS-CS demonstrated acceptable reliability (intraclass correlation coefficient = 0.69). CONCLUSION: The ESAS-CS and ESAS-r-CS NRS versions are valid and reliable for measuring symptoms in this population of outpatients with advanced cancer. Although the ESAS-r-CS was preferred, patients favored the 24-hour time window of the ESAS-CS, which also may best characterize fluctuating symptoms.
Authors: David Hausner; Nanor Kevork; Ashley Pope; Breffni Hannon; John Bryson; Jenny Lau; Gary Rodin; Lisa W Le; Camilla Zimmermann Journal: Support Care Cancer Date: 2018-05-30 Impact factor: 3.603
Authors: David Hui; Minjeong Park; Omar Shamieh; Carlos Eduardo Paiva; Pedro Emilio Perez-Cruz; Mary Ann Muckaden; Eduardo Bruera Journal: Cancer Date: 2016-03-11 Impact factor: 6.860
Authors: Pedro E Perez-Cruz; Omar Shamieh; Carlos Eduardo Paiva; Jung Hye Kwon; Mary Ann Muckaden; Eduardo Bruera; David Hui Journal: J Pain Symptom Manage Date: 2017-11-16 Impact factor: 3.612