Research Article
No access
Published Online: 1 March 2011

Edmonton Symptom Assessment Scale as a Prognosticative Indicator in Patients with Advanced Cancer

Publication: Journal of Palliative Medicine
Volume 14, Issue Number 3

Abstract

Background: Few studies incorporate patient self-assessment scales in prognostic models of survival prediction. The Edmonton Symptom Assessment Scale (ESAS) is commonly used as a symptom screening tool in cancer patients.
Objective: The goal of this study was to evaluate the prognostic value of the ESAS for survival prediction in the advanced cancer population.
Materials and Methods: Patients completed the ESAS and demographic information prior to palliative radiotherapy consultation and at follow-up at the Odette Cancer Centre between 1999 and 2009. Generalized estimating equation (GEE) methodology was applied to analyze ESAS trends within the last months of life. One-way analysis of variance (ANOVA) with repeated measurements was used to characterize trends between time periods.
Results: ESAS records (2377) from 808 patients (433 male and 375 female) were included in this cohort. Median age was 68 years (range 32–95) with median Karnofsky performance status (KPS) of 60 (range 10–100). Primary cancer sites were of the lung (36%), breast (20%), and prostate (19%). All nine ESAS symptoms significantly deteriorated in the last 4 weeks immediately before death when compared with those scores in the preceding months. At one week prior to death, the worst ESAS symptoms experienced by patients were fatigue, appetite, and well-being with mean scores of 7.4, 6.9, and 6.1, respectively.
Conclusions: All ESAS scores significantly worsened in the last 4 weeks prior to death compared with those in the previous months. Sudden deterioration of the global ESAS symptoms may predict impending death. Future studies on a prognostic model should incorporate both ESAS symptom severity and trends.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Chow EHarth THruby GFinkelstein JWu JDanjoux C. How accurate are physicians' clinical predictions of survival and the available prognostic tools in estimating survival times in terminally ill cancer patients? A systematic reviewClin Oncol (R Coll Radiol)200113209-218. 1. Chow E, Harth T, Hruby G, Finkelstein J, Wu J, Danjoux C: How accurate are physicians' clinical predictions of survival and the available prognostic tools in estimating survival times in terminally ill cancer patients? A systematic review. Clin Oncol (R Coll Radiol) 2001;13:209–218.
2.
Earle CCNeville BALandrum MBAyanian JZBlock SDWeeks JC. Trends in the aggressiveness of cancer care near the end of lifeJ Clin Oncol200422315-321. 2. Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC: Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol 2004;22:315–321.
3.
Glare PVirik KJones MHudson MEychmuller SSimes JChristakis N. A systematic review of physicians' survival predictions in terminally ill cancer patientsBr Med J2003327195-198. 3. Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes J, Christakis N: A systematic review of physicians' survival predictions in terminally ill cancer patients. Br Med J 2003;327:195–198.
4.
Chow EFung KPanzarella TBezjak ADanjoux CTannock I. A predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinicInt J Radiat Oncol Biol Phys2002531291-1302. 4. Chow E, Fung K, Panzarella T, Bezjak A, Danjoux C, Tannock I: A predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic. Int J Radiat Oncol Biol Phys 2002;53:1291–1302.
5.
Addington-Hall JMMacDonald LDAnderson HR. Can the Spitzer quality of life index help to reduce prognostic uncertainty in terminal care?Br J Cancer199062695-699 5. Addington-Hall JM, MacDonald LD, Anderson HR: Can the Spitzer quality of life index help to reduce prognostic uncertainty in terminal care? Br J Cancer 1990;62:695–699
6.
Bruera EMiller MJKuehn NMacEachern THanson J. Estimate of survival of patients admitted to a palliative care unit: A prospective studyJ Pain Symptom Manage1992782-86. 6. Bruera E, Miller MJ, Kuehn N, MacEachern T, Hanson J: Estimate of survival of patients admitted to a palliative care unit: A prospective study. J Pain Symptom Manage 1992;7:82–86.
7.
Christakis NALamont EB. Extent and determinants of error in doctors' prognoses in terminally ill patients: Prospective cohort studyBr Med J2000320469-472. 7. Christakis NA, Lamont EB: Extent and determinants of error in doctors' prognoses in terminally ill patients: Prospective cohort study. Br Med J 2000;320:469–472.
8.
Vigano ADorgan MBruera ESuarez-Almazor ME. The relative accuracy of the clinical estimation of the duration of life for patients with end of life cancerCancer199986170-176. 8. Vigano A, Dorgan M, Bruera E, Suarez-Almazor ME: The relative accuracy of the clinical estimation of the duration of life for patients with end of life cancer. Cancer 1999;86:170–176.
9.
Lamont EBChristakis NA. Some elements of prognosis in terminal cancerOncology (Williston)1999131165-1170. 9. Lamont EB, Christakis NA: Some elements of prognosis in terminal cancer. Oncology (Williston) 1999;13:1165–1170.
10.
Cheung WYBarmala NZarinehbaf SRodin GLe LWZimmermann C. The association of physical and psychological symptom burden with time to death among palliative cancer outpatientsJ Pain Symptom Manage200937297-304. 10. Cheung WY, Barmala N, Zarinehbaf S, Rodin G, Le LW, Zimmermann C: The association of physical and psychological symptom burden with time to death among palliative cancer outpatients. J Pain Symptom Manage 2009;37:297–304.
11.
Chang VTHwang SSFeuerman M. Validation of the Edmonton symptom assessment scaleCancer2000882164-2171. 11. Chang VT, Hwang SS, Feuerman M: Validation of the Edmonton symptom assessment scale. Cancer 2000;88:2164–2171.
12.
Bruera EKuehn NMiller MJSelmser PMacmillan K. The Edmonton symptom assessment system (ESAS): A simple method for the assessment of palliative care patientsJ Palliat Care199176-9. 12. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K: The Edmonton symptom assessment system (ESAS): A simple method for the assessment of palliative care patients. J Palliat Care 1991;7:6–9.
13.
Liang KYZeger SL. Longitudinal data analysis using generalized linear modelsBiometrika19867313-22. 13. Liang, KY, Zeger, SL: Longitudinal data analysis using generalized linear models. Biometrika 1986;73:13–22.
14.
Vigano ABruera ESuarez-Almazor ME. Terminal cancer syndrome: Myth or reality?J Palliat Care19991532-39. 14. Vigano A, Bruera E, Suarez-Almazor ME: Terminal cancer syndrome: Myth or reality? J Palliat Care 1999;15:32–39.
15.
Modonesi CScarpi EMaltoni MDerni SFabbri LMartini FSansoni EAmadori D. Impact of palliative care unit admission on symptom control evaluated by the Edmonton symptom assessment systemJ Pain Symptom Manage200530367-373. 15. Modonesi C, Scarpi E, Maltoni M, Derni S, Fabbri L, Martini F, Sansoni E, Amadori D: Impact of palliative care unit admission on symptom control evaluated by the Edmonton symptom assessment system. J Pain Symptom Manage 2005;30:367–373.
16.
Vigano ABruera EJhangri GSStephen CNewman MDFields ALSuarez-Almazor ME. Clinical survival predictors in patients with advanced cancerArch Intern Med2000160861-868. 16. Vigano A, Bruera E, Jhangri GS, Stephen C, Newman MD, Fields AL, Suarez-Almazor ME: Clinical survival predictors in patients with advanced cancer. Arch Intern Med 2000;160:861–868.
17.
Stromgren ASGroenwold MPedersen LOlsen AKSjogren P. Symptomology of cancer patients in palliative care: content validation of self-assessment questionnaires against medical recordsEur J Cancer.200238788-794. 17. Stromgren AS, Groenwold M, Pedersen L, Olsen AK, Sjogren P. Symptomology of cancer patients in palliative care: content validation of self-assessment questionnaires against medical records. Eur J Cancer. 2002;38:788–794.
18.
Presutti RZhang LTsao MBarnes EADanjoux CSahgal AMitera GSinclair EChow E. Projected referral for health care services in an out-patient palliative radiotherapy clinicJ Pain Manage2010381-88. 18. Presutti R, Zhang L, Tsao M, Barnes EA, Danjoux C, Sahgal A, Mitera G, Sinclair E, Chow E: Projected referral for health care services in an out-patient palliative radiotherapy clinic. J Pain Manage 2010;3:81–88.
19.
Fan GHadi SChow E. Symptom clusters in patients with advanced-stage cancer referred for palliative radiation therapy in an outpatient settingSupportive Cancer Ther20074157-162. 19. Fan G, Hadi S, Chow E: Symptom clusters in patients with advanced-stage cancer referred for palliative radiation therapy in an outpatient setting. Supportive Cancer Ther 2007;4:157–162.
20.
Maltoni MPirovano MScarpi EMarinari MIndelli MArnoldi EGallucci MFrontini LPiva LAmadori D. Prediction of survival of patients terminally ill with cancer: Results of an Italian prospective multicentric studyCancer1995752613-2622. 20. Maltoni M, Pirovano M, Scarpi E, Marinari M, Indelli M, Arnoldi E, Gallucci M, Frontini L, Piva L, Amadori D: Prediction of survival of patients terminally ill with cancer: Results of an Italian prospective multicentric study. Cancer 1995;75:2613–2622.
21.
Palmer JLFisch MJ. Association between symptom distress and survival in outpatients seen in a palliative care cancer centerJ Pain Symptom Manage200529565-571. 21. Palmer JL, Fisch MJ: Association between symptom distress and survival in outpatients seen in a palliative care cancer center. J Pain Symptom Manage 2005;29:565–571.
22.
Fulton CL. The physical and psychological symptoms experienced by patients with metastatic breast cancer before deathEur J Cancer Care (Engl)19976262-266. 22. Fulton CL: The physical and psychological symptoms experienced by patients with metastatic breast cancer before death. Eur J Cancer Care (Engl) 1997;6:262–266.
23.
Nelson JEMeier DEOei EJNierman DMSenzel RSManfredi PLDavis SMMorrison RS. Self-reported symptom experience of critically ill cancer patients receiving intensive careCrit Care Med200129277-282. 23. Nelson JE, Meier DE, Oei EJ, Nierman DM, Senzel RS, Manfredi PL, Davis SM, Morrison RS: Self-reported symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med 2001;29:277–282.
24.
Coates APorzsolt FOsoba D. Quality of life in oncology practice: Prognostic value of EORTC QLQ-C30 scores in patients with advanced malignancyEur J Cancer1997331025-1030. 24. Coates A, Porzsolt F, Osoba D: Quality of life in oncology practice: Prognostic value of EORTC QLQ-C30 scores in patients with advanced malignancy. Eur J Cancer 1997;33:1025–1030.
25.
Moro CBrunelli CMiccinesi GFallal MMorino PPiazza MLabianca RRipamonti C. Edmonton symptom assessment scale: Italian validation in two palliative care settingsSupport Care Cancer20061430-37. 25. Moro C, Brunelli C, Miccinesi G, Fallal M, Morino P, Piazza M, Labianca R, Ripamonti C: Edmonton symptom assessment scale: Italian validation in two palliative care settings. Support Care Cancer 2006;14:30–37.
26.
Vignaroli EPace EAWilley JPalmer JLZhang TBruera E. The Edmonton symptom assessment system as a screening tool for depression and anxietyJ Palliat Med20069296-303. 26. Vignaroli E, Pace EA, Willey J, Palmer JL, Zhang T, Bruera E: The Edmonton symptom assessment system as a screening tool for depression and anxiety. J Palliat Med 2006;9:296–303.
27.
Lau FMaida VDowning MLesperance MKarlson NKuziemsky C. Use of the palliative performance scale (PPS) for end-of-life prognostication in a palliative medicine consultation serviceJ Pain Symptom Manage200937965-972. 27. Lau F, Maida V, Downing M, Lesperance M, Karlson N, Kuziemsky C: Use of the palliative performance scale (PPS) for end-of-life prognostication in a palliative medicine consultation service. J Pain Symptom Manage 2009;37:965–972.
28.
Weng LCHuang HLWilkie DJHoenig NASuarez MLMarschke MDurham J. Predicting survival with the palliative performance scale in a minority-serving hospice and palliative care programJ Pain Symptom Manage200937642-648. 28. Weng LC, Huang HL, Wilkie DJ, Hoenig NA, Suarez ML, Marschke M, Durham J: Predicting survival with the palliative performance scale in a minority-serving hospice and palliative care program. J Pain Symptom Manage 2009;37:642–648.
29.
Head BRitchie CSSmoot TM. Prognostication in hospice care: Can the palliative performance scale help?J Palliat Med20058492-502. 29. Head B, Ritchie CS, Smoot TM: Prognostication in hospice care: Can the palliative performance scale help? J Palliat Med 2005;8:492–502.
30.
Chow EAbdolell MPanzarella THarris KBezjak AWarde PTannock I. Validation of a predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinicInt J Radiat Oncol Biol Phys200973280-287. 30. Chow E, Abdolell M, Panzarella T, Harris K, Bezjak A, Warde P, Tannock I: Validation of a predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic. Int J Radiat Oncol Biol Phys 2009;73:280–287.
31.
Rees EHardy JLing JBroadley KA'Hern R. The use of the Edmonton symptom assessment scale (ESAS) within a palliative care unit in the UKPalliat Med19981275-82. 31. Rees E, Hardy J, Ling J, Broadley K, A'Hern R: The use of the Edmonton symptom assessment scale (ESAS) within a palliative care unit in the UK. Palliat Med 1998;12:75–82.
32.
Chow ELing ADavis LPanzarella TDanjoux C. Pain flare following external beam radiotherapy and meaningful change in pain scores in the treatment of bone metastasesRadiother Oncol20057564-69. 32. Chow E, Ling A, Davis L, Panzarella T, Danjoux C: Pain flare following external beam radiotherapy and meaningful change in pain scores in the treatment of bone metastases. Radiother Oncol 2005;75:64–69.

Information & Authors

Information

Published In

cover image Journal of Palliative Medicine
Journal of Palliative Medicine
Volume 14Issue Number 3March 2011
Pages: 337 - 342
PubMed: 21254813

History

Published in print: March 2011
Published online: 1 March 2011
Published ahead of print: 21 January 2011
Accepted: 3 November 2010

Permissions

Request permissions for this article.

Topics

    Authors

    Affiliations

    Liang Zeng
    Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
    Liying Zhang
    Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
    Shaelyn Culleton
    Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
    Florencia Jon
    Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
    Lori Holden
    Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
    Justin Kwong
    Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
    Luluel Khan
    Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
    May Tsao
    Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
    Cyril Danjoux
    Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
    Arjun Sahgal
    Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
    Elizabeth Barnes
    Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
    Edward Chow
    Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.

    Notes

    Address correspondence to:Edward Chow MBBS, M.Sc., Ph.D., FRCPCDepartment of Radiation OncologySunnybrook Health Sciences Centre2075 Bayview AvenueToronto, ON M4N 3M5Canada
    E-mail: [email protected]

    Author Disclosure Statement

    No competing financial interests exist.

    Metrics & Citations

    Metrics

    Citations

    Export citation

    Select the format you want to export the citations of this publication.

    View Options

    Get Access

    Access content

    To read the fulltext, please use one of the options below to sign in or purchase access.

    Society Access

    If you are a member of a society that has access to this content please log in via your society website and then return to this publication.

    Restore your content access

    Enter your email address to restore your content access:

    Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

    View options

    PDF/EPUB

    View PDF/ePub

    Full Text

    View Full Text

    Media

    Figures

    Other

    Tables

    Share

    Share

    Copy the content Link

    Share on social media

    Back to Top