The Edmonton Symptom Assessment System (ESAS) as a screening tool for depression and anxiety in non-advanced patients with solid or haematological malignancies on cure or follow-up.
Ripamonti C I, Bandieri E, Pessi MA, Maruelli A, Buonaccorso L, Miccinesi G.
Support Care in Cancer. 2013 Nov 26. [Epub ahead of print] PMID: 2427695 [PubMed - as supplied by publisher]
Contrary to the common belief, there is no difference in the prevalence of depression, adjustment disorders, and anxiety between palliative and non-palliative settings. The combination of anxiety and depression appeared slightly more common in non-palliative care patients. However in oncological settings, symptoms' assessment using screening tools is frequently considered only for patients involved in clinical trials despite recommendations that all cancer patients should be screened for pain and other physical symptoms as well as their level of distress starting from the initial visit with their oncologist. Data from the literature show that oncologists have a good knowledge about the main symptoms of depression in cancer patients and a positive attitude toward being involved in screening, but they lack contact time to screen and this is the main barrier to the diagnosis. The diagnostic criteria for depression are considered difficult to apply. There is also a lack of a simple, brief, easy to administer and interpret, non-time consuming tools to further investigate anxiety and depression that might lead to early treatment or referral to specialists.
The main objective of the study was to assess the performance of the Edmonton Symptom Assessment System (ESAS) items on anxiety and depression when detecting Hospital Anxiety Depression Scale (HADS) 'cases' and to identify the best cut off values in non-advanced patients with solid or haematological malignancies and with no metastases on oncological therapies or follow-up.
A cross-sectional study was carried out on 194 non-advanced patients with solid (108) or hematologic malignancies on cure or follow up, Karnofsky Performance Status ≥ 70, life expectancy > 6 months and no metastases.
Patients were assessed by means of both the ESAS and HADS. Receiving operator characteristic (ROC) analysis of ESAS anxiety and depression items versus cases of severe (cut off 11) anxiety and depression according to HADS specific subscales was performed.
Depression and anxiety ESAS items correlated strongly (.707, Spearman). Area under the curve ranged between 0.84 and 0.96 for the two ESAS items when detecting severe anxiety or depression HADS cases (cut off=11). ESAS anxiety or depression scores >3 detected quite well the severe depression HADS cases (Sensibility=75-Specificity=84, Sensibility=87, Specificity=90, respectively).
Conclusions: Anxiety or depression ESAS items score >3 can be used as a useful, easy, and not time consuming screening tool for assessing anxiety and depression in non-advanced patients with solid or haematological malignancies.
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