The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

Abstract

Context Routine symptom assessment represents the cornerstone of symptom management. ESAS is one of the first quantitative symptom assessment batteries that allows for simple and rapid documentation of multiple patient-reported symptoms at the same time. Objective To discuss the historical development of ESAS, its current uses in different settings, and future developments. Methods Narrative review Results Since its development in 1991, ESAS has been psychometrically validated and translated into over 20 languages. We will discuss the variations, advantages and limitations with ESAS. From the clinical perspective, ESAS is now commonly used for symptom screening and longitudinal monitoring in patients seen by palliative care, oncology, nephrology, and other disciplines in both inpatient and outpatient settings. From the research perspective, ESAS has offered important insights into the nature of symptom trajectory, symptom clusters and symptom modulators. Furthermore, multiple clinical studies have incorporated ESAS as a study outcome and documented the impact of various interventions on symptom burden. On the horizon, multiple groups are actively investigating further refinements to ESAS, such as incorporating it in electronic health records, employing ESAS as a trigger for palliative care referral, and coupling ESAS with personalized symptom goals to optimize symptom response assessment. Conclusion ESAS has evolved over the past 25 years to become an important symptom assessment instrument in both clinical practice and research. Future efforts are needed to standardize this tool and explore its full potential to support symptom management.

Prevalence of physical problems detected by the distress thermometer and problem list in patients with breast cancer

“…A primary weakness of this study is a lack of another validated measure of physical symptom burden, as opposed to measures such as the Edmonton Symptom Assessment System or the Functional Assessment of Cancer Therapy‐Breast Cancer, which have been validated as patient‐reported outcome measures . Also, stage and length of time with breast cancer and whether they were currently undergoing treatment were not captured and may have provided more information on the timing of when symptoms arise.…”

Baseline Edmonton Symptom Assessment System and Survival in Metastatic Renal Cell Carcinoma

“…Each of the 9 symptoms within the esas are rated on a scale from 0 to 10, with higher scores representing greater symptom burden (Figure 1). The esas was originally developed and validated to assess symptoms in patients receiving palliative care, and it has been demonstrated to provide prognostic information in that population 5 . It has since been validated for use in patients with cancer 6,7 .…”

Response to Oral Immediate-Release Opioids for Breakthrough Pain in Patients with Advanced Cancer with Adequately Controlled Background Pain

“…These results also affirm that a subgroup of patients with advanced cancer (who are younger and have higher ESAS scores for pain, anxiety, and dyspnea) requires closer monitoring and may need a relatively higher dose of BTP analgesia compared with those who are older and have lower ESAS scores. Our finding of a higher ESAS dyspnea score (when adjusted for age) as a significant factor predicting poor response to oral IR opioids emphasizes the importance of a more global symptom assessment and not just pain using symptom assessment tools such as ESAS in oncology clinics during routine follow‐up visits while patients are on active oncological treatment. Such patients who express higher degree of symptom distress can then be identified and referred earlier to a palliative care team .…”