Skip to main content

Advertisement

SpringerLink
Log in

Edmonton symptom assessment scale: Italian validation in two palliative care settings

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

In the palliative care setting, the Edmonton Symptom Assessment Scale (ESAS) was developed for use in daily symptom assessment of palliative care patients. ESAS considers the presence and severity of nine symptoms common in cancer patients: pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath plus an optional tenth symptom, which can be added by the patient. The aim of this study was to validate the Italian version of ESAS and to evaluate an easy quality of life monitoring system that uses a patient’s self-rating symptom assessment in two different palliative care settings: in-patients and home patients. Eighty-three in-patients and 158 home care patients were enrolled. In the latter group, the Italian validated version of the Symptom Distress Scale (SDS) was also administered at the admission of the patients. The two groups of patients have similar median survival, demographic and clinical characteristics, symptom prevalence and overall distress score at baseline. ESAS shows a good concurrent validity with respect to SDS. The correlation between the physical items of ESAS and SDS was shown to be higher than the correlation between the psychological items. The association of ESAS scores and performance status (PS) showed a trend: the higher the symptom score was, the worse was the PS level. Test–retest evaluation, applied in the in-patient group, showed good agreement for depression, well-being and overall distress and a moderate agreement for all the other items. In conclusion, ESAS can be considered a valid, reliable and feasible instrument for physical symptom assessment in routine “palliative care” clinical practice with a potentially different responsiveness in different situations or care settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Finlay IG, Dunlop R (1994) Quality of life assessment in palliative care. Ann Oncol 5:13–18

    CAS  Google Scholar 

  2. Gough IR, Furnival CM, Schilder L, Grove W (1983) Assessment of quality of life of patients with advanced cancer. Eur J Cancer Clin Oncol 19:1161–1165

    Google Scholar 

  3. Cohen SR, Mounth BM (1992) Quality of life in terminal illness: defining and measuring subjective well-being in the dying. J Palliat Care 3:40–45

    Google Scholar 

  4. Hopwood P (1992) Progress, problems and priorities in quality of life research. Eur J Cancer 28A(10):1748–1752

    Article  CAS  PubMed  Google Scholar 

  5. Aaronson NK, Bullinger M, Ahmedzai S (1988) A modular approach to quality of life assessment in cancer clinical trials. Recent Results Cancer Res 111:231–249

    CAS  PubMed  Google Scholar 

  6. Ferrel BR, Wisdom C, Wenzel C (1989) Quality of life as an outcome variable in the management of cancer pain. Cancer 63(11 Suppl):2321–2327

    Google Scholar 

  7. Slevin ML, Plant H, Lynch D, Drinkwater J, Gergory WM (1988) Who should measure quality of life: the doctor or the patient? Br J Cancer 57:109–112

    Google Scholar 

  8. Padilla GV, Ferrel B, Grant MM et al (1990) Defining the content of domain of quality of life for cancer patients with pain. Cancer Nurs 13(2):108–115

    CAS  PubMed  Google Scholar 

  9. McEvoy MD, McCorkle R (1990) Quality of life issues in patients with disseminated breast cancer. Cancer 66(6 Suppl):1416–1421

    Google Scholar 

  10. Bliss JM, Selby PJ, Robertson B et al (1992) A method of assessing quality of life of cancer patients: replication of the factor structure. Br J Cancer 65(6):961–966

    Google Scholar 

  11. Grant MM, Padilla GV, Ferrel BR et al (1990) Assessment of quality of life with a single instrument. Semin Oncol Nurs 6(4):260–270

    CAS  PubMed  Google Scholar 

  12. Maguire P, Selby P (1989) Assessing quality of life in cancer patients. Br J Cancer 60(3):437–440

    CAS  PubMed  Google Scholar 

  13. Caraceni A, Cherny N et al (2002) Pain measurement tools and methods in clinical research in palliative care: recommendation of an expert working group of the European Association of Palliative Care. J Pain Symptom Manage 23:239–255

    Article  PubMed  Google Scholar 

  14. Aaronson NK (1986) Methodological issues in psychosocial oncology with special reference to clinical trials. In: Ventafridda V, van Dam F, Yanick R et al (eds) Assessment of quality of life and cancer treatment. Elsevier, Amsterdam, pp 29–41

    Google Scholar 

  15. Schipper H, Clinch J et al (1984) Measuring the quality of life of cancer patients: the functional living index-cancer: development and validation. J Clin Oncol 2:472–483

    CAS  PubMed  Google Scholar 

  16. Tamburini M, Rosso S et al (1992) A therapy impact questionnaire for quality of life assessment in advanced cancer research. Ann Oncol 3:565–570

    CAS  PubMed  Google Scholar 

  17. Bruera E, Kuehn N, Miller M et al (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9

    CAS  PubMed  Google Scholar 

  18. Higginson I, Wade AM et al (1992) Effectiveness of two palliative support teams. J Public Health Med 14:50–56

    CAS  PubMed  Google Scholar 

  19. Bruera E, MacDonald S (1993) Audit methods the edmonton symptom assessment system. In: Higginson I (ed) Clinical audit in palliative care. Radcliffe Medical, Oxford, pp 61–77

    Google Scholar 

  20. Philip J et al (1998) Concurrent validity of the modified Edmonton Symptom Assessment Scale (ESAS) with the Rotterdam Symptom Checklist and the Brief Pain Inventory. Support Care Cancer 6:539–541

    Google Scholar 

  21. Rees E et al (1998) The use of the Edmonton Symptom Assessment Scale (ESAS) within a palliative care unit in the UK. Palliat Med 12:75–82

    Article  CAS  PubMed  Google Scholar 

  22. Dudgeon D et al (1999) The Edmonton Symptom Assessment Scale as an audit tool. J Palliat Care 15(3):14–19

    CAS  PubMed  Google Scholar 

  23. Chang V et al (2000) Validation of the Edmonton Symptom Assessment Scale. Cancer 88:2164–2171

    Google Scholar 

  24. Heedman P et al (2001) Symptom assessment in advanced palliative home care for cancer patients using the ESAS: clinical aspects. Anticancer Res 21:4077–4082

    Google Scholar 

  25. Strômgren A et al (2002) Self assessment in cancer patients referred to palliative care. Cancer 94:512–520

    Google Scholar 

  26. Nekolaichuk CL, Bruera E (1999) A comparison of patients and proxy symptom assessments in advanced cancer patients. Palliat Med 13:311–323

    Article  CAS  PubMed  Google Scholar 

  27. McCorkle R, Young K (1978) Development of a Symptom Distress Scale. Cancer Nurs 1:373–378

    CAS  PubMed  Google Scholar 

  28. Sze FK, Chung TK (1998) Pain in Chinese cancer patients under palliative care. Palliat Med 12:271–278

    Article  CAS  PubMed  Google Scholar 

  29. Deloach LJ, Higgins MS (1998) The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numerical scale. Anesth Analg 86:102–106

    Article  CAS  PubMed  Google Scholar 

  30. Giorgi F, Cellerino R (1996) Assessing quality of life in patients with cancer: a comparison of visual analogue and a categorical mode. Am J Clin Oncol 19:394–399

    Article  CAS  PubMed  Google Scholar 

  31. Peruselli C et al (1993) Quality of life assessment in a home care program for advanced cancer patients: a study using the Symptom Distress Scale. J Pain Symptom Manage 8:306–311

    Article  CAS  PubMed  Google Scholar 

  32. Fayers PM, Machin D (2000) Quality of life assessment analysis and interpretation. Wiley, New York (hard cover)

    Google Scholar 

  33. Higginson I et al (1990) Palliative care: views of patients and their families. BMJ 301:277–281

    CAS  PubMed  Google Scholar 

  34. Peruselli C et al (1997) Outcome evaluation in a home palliative care service. J Pain Symptom Manage 13:158–165

    Article  CAS  PubMed  Google Scholar 

  35. Schwartz CE et al (2004) Reconsidering the psychometrics of quality of life assessment in light of response shift and appraisal. Health Qual Life Outcomes 2:16

    Article  PubMed  Google Scholar 

  36. Heedman PA, Strang P (2003) Pain and pain alleviation in hospital-based home care: demographic, biological and treatment factors. Support Care Cancer 11:35–40

    Google Scholar 

  37. Stromgren AS, Groenvold M (2002) Symptomatology of cancer patients in palliative care: content validation of self-assessment questionnaires against medical records. Eur J Cancer 38:788–794

    Google Scholar 

  38. Fisch MJ, Titzer ML (2003) Assessment of quality of life in outpatients with advanced cancer: the accuracy of clinician estimation and the relevance of spiritual well being—a Hoosier Oncology Group study. J Clin Oncol 21:2754–2759

    Article  PubMed  Google Scholar 

  39. MacClain CS, Rosenfeld B (2003) Effect of spiritual well-being on end of life despair in terminally ill cancer patients. Lancet 361:1603–1607

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Oncology Unit, Ospedali Riuniti di Bergamo, Bergamo, Italy

    Cecilia Moro & Roberto Labianca

  2. Rehabilitation and Palliative Care Operative Unit, National Cancer Institute, Via Venezian, 1, 20133, Milan, Italy

    Cinzia Brunelli & Carla Ripamonti

  3. Epidemiology Unit, CSPO, Florence, Italy

    Guido Miccinesi

  4. Palliative Care Unit, ASL 10, Florence, Italy

    Mauro Fallai, Piero Morino & Massimo Piazza

Authors
  1. Cecilia Moro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cinzia Brunelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guido Miccinesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mauro Fallai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Piero Morino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Massimo Piazza
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Roberto Labianca
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carla Ripamonti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carla Ripamonti.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moro, C., Brunelli, C., Miccinesi, G. et al. Edmonton symptom assessment scale: Italian validation in two palliative care settings. Support Care Cancer 14, 30–37 (2006). https://doi.org/10.1007/s00520-005-0834-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-005-0834-3

Keywords

Search

Navigation