What is the Edmonton Symptom Assessment Scale (ESAS)?

From the Guidelines

The Edmonton Symptom Assessment Scale (ESAS) is a clinical tool used to assess nine common symptoms experienced by patients, evaluating pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, wellbeing, and shortness of breath on a numerical scale from 0 to 10. The ESAS is utilized in various clinical settings, including palliative care for cancer patients and those with advanced heart failure, as seen in studies such as 1 and 1.

Key Features of ESAS

• It assesses symptoms on a numerical scale from 0 to 10, with higher numbers indicating greater symptom severity
• Patients rate their symptoms based on how they feel at the time of assessment or within the past 24 hours
• The ESAS is typically administered daily in inpatient settings or at each clinic visit for outpatients
• It provides a standardized approach to symptom assessment, improving communication between patients and healthcare providers
• The simplicity of the numerical rating system makes it accessible to most patients, even those who are quite ill, as noted in 1

Clinical Applications

• The ESAS can be used to track symptom changes over time and adjust treatment plans accordingly
• It helps identify symptoms that might otherwise go unrecognized, such as depression, fatigue, and poor appetite, which can be regarded as unimportant given the seriousness of the underlying condition, as mentioned in 1
• The ESAS can be used in conjunction with other assessment tools, such as the Numeric Rating Scale (NRS) or the Integrated Palliative care Outcome Scale (IPOS), to assess symptoms comprehensively, as discussed in 1

From the Research

Overview of the Edmonton Symptom Assessment Scale

• The Edmonton Symptom Assessment System (ESAS) is a tool used for self-reporting of symptom intensity, initially developed for advanced cancer patients 2, 3, 4.
• It consists of 11-point numerical rating scales for nine common symptoms of cancer, with a 10th scale for a patient-specific symptom 2.
• The ESAS has undergone widespread adoption internationally for clinical, research, and administrative purposes 2, 4.

Components and Administration of the ESAS

• The ESAS includes numerical rating scales for symptoms such as pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, feeling of well-being, and shortness of breath 3, 5.
• Patients are asked to rate their symptoms based on their current experience, with higher scores indicating greater symptom severity 2, 3.
• The ESAS can be administered in various settings, including inpatient and outpatient care, and can be used for symptom screening and longitudinal monitoring 4.

Validation and Reliability of the ESAS

• Studies have validated the ESAS as a reliable tool for assessing symptom severity in cancer patients 2, 3, 4.
• The ESAS has been shown to be associated with other measures of symptom severity, such as the Epworth Sedation Scale and the Pittsburgh Sleep Quality Index 5.
• However, some studies have raised concerns about the feasibility and usefulness of the ESAS, highlighting the need for further validation research 2, 6.

Patient Perspectives on the ESAS

• Patients have reported that the ESAS is easy to complete, but may require clarification on certain terms, such as tiredness versus drowsiness, and depression versus anxiety 6.
• Patients have also expressed a need to emphasize the timeframe of the assessment, with some suggesting that the ESAS should be completed in the presence of a healthcare professional 6.
• Overall, the ESAS has been shown to be a valuable tool for assessing symptom severity in cancer patients, but may require further refinement and validation to ensure its effectiveness 2, 4.