The utility of the Edmonton Symptom Assessment System in screening for anxiety and depression

Abstract

The Edmonton Symptom Assessment System (ESAS) is a common screening tool in cancer, although its validity for distress screening is unproven. Here, screening performance of the ESAS anxiety (ESAS-A) and depression (ESAS-D) items were validated against the anxiety [Generalised Anxiety Disorder-7 (GAD-7)] and depression [Patient Health Questionnaire-9 (PHQ-9)] subscales of the PHQ. A total of 1215 cancer patients completed the Distress Assessment and Response Tool (DART), a computerised distress screening instrument. Spearman's rank correlation coefficients and receiver operating characteristic curve analyses were used to evaluate the ability of ESAS-A and ESAS-D to identify moderate distress (GAD-7/PHQ-9 ≥ 10). Spearman's rank correlation coefficients comparing ESAS-A and ESAS-D with GAD-7 and PHQ-9 were 0.74 and 0.72 respectively. Areas under the receiver operating characteristic curves were 0.89 and 0.88 for anxiety and depression respectively. A cut-off of ≥3 on ESAS-A demonstrated a sensitivity of 0.91, specificity of 0.68, positive predictive value of 0.34 and negative predictive value of 0.97. A cut-off of ≥2 on the ESAS-D demonstrated a sensitivity of 0.86, specificity of 0.72, positive predictive value of 0.46 and negative predictive value of 0.95. High sensitivities of ESAS-A and ESAS-D at certain cut-offs suggest they have use in ruling-out distress. However, their low specificities indicate secondary screening is needed to rule-in anxiety or depression for case-finding.

Feasibility and diagnostic accuracy of the Patient‐Reported Outcomes Measurement Information System (PROMIS) item banks for routine surveillance of sleep and fatigue problems in ambulatory cancer care

“…These studies did not assess the diagnostic accuracy of PROMIS ® CAT in comparison to legacy measures using a Receiver Operator Characteristic (ROC) methodology. The use of ROC has been previously used to test the discriminant power for comparison of outcome measures as expressed in sensitivity and specificity in the osteoporosis and cancer populations and to determine important cutoff scores for use in clinical practice [40][41][42] . Whereas, there have been some cross-walking of the FACIT-Fatigue scores to PROMIS ® T-scores 43 , comparison of legacy measures for insomnia and PROMIS has not been previously examined.…”

Understanding and Addressing the Informational Needs of Radiation Therapists Concerning the Management of Anxiety and Depression in Patients Receiving Radiation Therapy Treatment

“…Unfortunately it appears that the ESAS scores are currently not easily accessible to RTs. Since many respondents believe that including this symptom analysis is important in the RTs' daily clinical practice, and has been found in other studies to be reliable in screening for anxiety and depression [1,12], this should be an area for future study to improve the ability of RTs to easily access and use ESAS information.…”

“…This patient-reported information is typically utilized by the Radiation Oncologist and Radiation Oncology Nurses, however is not always utilized by the RTs. It has been found that ESAS is a simple but valid tool for assessing anxiety and depression in patients [1,12].…”

The Edmonton Symptom Assessment System: Poor performance as screener for major depression in patients with incurable cancer

“…Vignaroli et al (42). They found that ESAS-Depression performed well compared to PHQ-9 sumscore (≥10 of 27) and proposed ESAS-Depression as an initial screening instrument to exclude non-depressed patients before screening with a more extended instrument.…”

“…In a two-step screening procedure, sensitivity in the first step would be most important to not overlook depressed subjects; sensitivity of 0.85 was considered putative for this purpose (42). …”