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

Authors

  • S.M. BAGHA MSC, MSW,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada
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  • A. MACEDO MSCOT,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada
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  • L.M. JACKS MSC,

    1. Cancer Care Ontario, Toronto
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  • C. LO PHD,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada
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  • C. ZIMMERMANN MD, PHD,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, and Ontario Cancer Institute, University Health Network, Toronto
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  • G. RODIN MD,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, and Ontario Cancer Institute, University Health Network, Toronto
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  • M. LI MD, PHD

    Corresponding author
    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada
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  • Funding: No specific funding used.

  • Financial disclosures: No financial conflicts of interest disclosed.

Madeline Li, Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, 610 University Avenue Toronto, Ontario, Canada M5G 2M9 (e-mail: madeline.li@uhn.on.ca).

Abstract

BAGHA S.M., MACEDO A., JACKS L.M., LO C., ZIMMERMANN C., RODIN G. & LI M. (2013) European Journal of Cancer Care22, 60–69

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

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.

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