Baseline prevalence of Edmonton Symptom Assessment System (ESAS) scores in the general population of Ontario, Canada

Alice Zhu, Victoria Delibasic, Laura E. Davis, Lev Bubis, Natalie G. Coburn

Abstract


Background: The Edmonton Symptom Assessment System (ESAS) is used to assess symptoms in cancer patients across Ontario, but comparisons with the general population are lacking.

Methods: We conducted a cross-sectional online survey of 3,000 individuals from the general Ontario population using the ESAS questionnaire. We examined the prevalence of moderate-to-severe and severe symptom scores, stratified by age groups, and performed multivariable logistic regression to identify risk factors for elevated symptom burden.

Results: Among participants, 70.8% reported at least one moderate-to-severe symptom, and 43.6% reported at least one severe symptom. Younger age, additional health concerns, lower income, lower education, and female sex were associated with higher odds of elevated symptom burden. Associations with marital status, ethnicity, and area of residence were mixed.

Conclusion: By revealing the high prevalence of moderate-to-severe symptoms in the general population, this study emphasizes the importance of evaluating baseline symptomatology and monitoring changes in symptom burden among cancer patients. 

https://doi.org/10.5737/23688076364398


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Aburub, A. S., Gagnon, B., Ahmed, S., Rodriguez, A. M., & Mayo, N. E. (2018). Impact of reconceptualization response shift on rating of quality of life over time among people with advanced cancer. Supportive Care in Cancer, 26(9), 3063–3071. https://doi.org/10.1007/s00520-018-4156-7

ALHosni, F., AL Qadire, M., Omari, O.A., Al Raqaishi, H., & Khalaf, A. (2023). Symptom prevalence, severity, distress and management among patients with chronic diseases. BMC Nursing, 22(1), 155. https://doi.org/10.1186/s12912-023-01296-8

Armijo-Olivo, S. (2018). The importance of determining the clinical significance of research results in physical therapy clinical research. Brazilian Journal of Physical Therapy, 22(3), 175–176. https://doi.org/10.1016/j.bjpt.2018.02.001

Arndt, V., Merx, H., Stürmer, T., Stegmaier, C., Ziegler, H., & Brenner, H. (2004). Age-specific detriments to quality of life among breast cancer patients one year after diagnosis. European Journal of Cancer, 40(5), 673-680. https://doi.org/10.1016/j.ejca.2003.12.007

Barbera, L., Sutradhar, R., Earle, C. C., Howell, D., Mittman, N., Li, Q., Thiruchelvam, D., & Seow, H. (2020). The impact of routine Edmonton Symptom Assessment System use on receiving palliative care services: Results of a population-based retrospective-matched cohort analysis. BJM Support & Palliative Care, 13(e1), e144–e149. https://doi.org/10.1136/bmjspcare-2020-002220

Barbera, L., Sutradhar, R., Howell, D., Sussman, J., Seow, H., Dudgeon, D., Atzema, C., Earle, C., Husain, A., Liu, Y, & Krzyzanowska, M. K., (2015). Does routine symptom screening with ESAS decrease ED visits in breast cancer patients undergoing adjuvant chemotherapy? Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 23(10), 3025–3032. https://doi.org/10/1007/s00520-015-2671-3

Barbera, K., Sutradhar, R. Seow, H., Earle, C. C., Howell, D., Mittmann, N., Li, Q., & Thiruchelvam, D. (2020). Impact of standardized Edmonton Symptom Assessment System use on emergency department visits and hospitalization: Results of a population-based retrospective matched cohort analysis. JCO Oncology Practice, 16(9), e958–e965. https://doi.org/10.1200/JOP.19.00660

Bardel, A., Wallander, M. A., Wallman, T., Rosengren, A., Johansson, S., Eriksson, H., & Svärdsudd, K. (2019). Age and sex related self-reported symptoms in a general population across 30 years: Patterns of reporting and secular trend. PloS one, 14(2), e0211532. https://doi.org/10.1371/journal.pone.0211532

Basch, E., Barbera, L., Kerrigan, C. L., & Velikova, G. (2018). Implementation of patient-reported outcomes in routine medical care. American Society of Clinical Oncology Educational Book. American Society of Clinical Oncology. Annual Meeting, 38, 122–134. https://doi.org/10.1200/EDBK_200383

Basch, E., Deal, A. M., Dueck, A. C., Scher, H. I., Kris, M. G., Hudis, C., & Schrag, D. (2017). Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA, 318(2), 197–198. https://doi.org/10.1001/jama.2017.7156

Basch, E., Snyder, C., McNiff, K., Brown, R., Maddux, S., Smith, M. L., Atkinson, T. M., Howell, D., Chiang, A., Wood, W., Levitan, N., Wu, A. W., & Krzyzanowska, M. (2014). Patient-reported outcome performance measures in oncology. Journal of Oncology Practice, 10(3), 209–211. https://doi.org/10.1200/JOP.2014.001423

Bonanno G. A. (2004). Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? The American Psychologist, 59(1), 20–28. https://doi.org/10.1037/0003-066X.59.1.20

Bonnaud-Antignac, A., Bourdon, M., Dréno, B., & Quéreux, G. (2017). Coping strategies at the time of diagnosis and quality of life 2 years later: A Study in primary cutaneous melanoma patients. Cancer Nursing, 40(1), E45–E53. https://doi.org/10.1097/NCC.0000000000000337

Breetvelt, I. S., & Van Dam, F. S. (1991). Underreporting by cancer patients: The case of response-shift. Social Science & Medicine (1982), 32(9), 981–987. https://doi.org/10.1016/0277-9536(91)90156-7

Bruera, E., Kuehn, N., Miller, M. J., Selmser, P., & Macmillan, K. (1991). The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care, 7(2), 6–9.

Bubis, L. D., Davis, L., Mahar, A., Barbera, L., Li, Q., Moody, L., Karanicolas, P., Sutradhar, R., & Coburn, N. G. (2018). Symptom burden in the first year after cancer diagnosis: An analysis of patient-reported outcomes. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 36(11), 1103–1111. https://doi.org/10.1200/JCO.2017.76.0876

Butt, Z., Wagner, L. I., Beaumont, J. L., Paice, J. A., Peterman, A. H., Shevrin, D., Von Roenn, J. H., Carro, G., Straus, J. L., Muir, J. C., & Cella, D. (2008). Use of a single-item screening tool to detect clinically significant fatigue, pain, distress, and anorexia in ambulatory cancer practice. Journal of Pain and Symptom Management, 35(1), 20–30. https://doi.org/10.1016/j.jpainsymman.2007.02.040

Cancer Care Ontario. (2016). Patient-reported outcomes and symptom management program: Strategic framework 2016–2019. Ontario Health.

Cancer Care Ontario. (2020). Ontario cancer statistics 2020. Ontario Health. https://www.cancercareontario.ca/en/statistical-reports/ontario-cancer-statistics-2020/ch-1-estimated-current-cancer-incidence

Carver, C. S. (1998). Resilience and thriving: Issues, models, and linkages. Journal of Social Issues, 54(2), 245–266. https://doi.org/10.1111/j.1540-4560.1998.tb01217.x

Champion, V. L., Wagner, L. I., Monahan, P. O., Daggy, J., Smith, L., Cohee, A., Ziner, K. W., Haase, J. E., Miller, K. D., Pradhan, K., Unverzagt, F. W., Cella, D., Ansari, B., & Sledge, G. W., Jr (2014). Comparison of younger and older breast cancer survivors and age-matched controls on specific and overall quality of life domains. Cancer, 120(15), 2237–2246. https://doi.org/10.1002/cncr.28737

Dutton, W. H., & Blank, G. (2014). The emergence of next generation internet users. International Economics and Economic Policy, 11, 29–47. https://doi.org/10.1007/s10368-013-0245-8

Given, B., & Given, C. W. (2008). Older adults and cancer treatment. Cancer, 113(12 Suppl), 3505–3511. https://doi.org/10.1002/cncr.23939

Gouzman, J., Cohen, M., Ben-Zur, H., Shacham-Shmueli, E., Aderka, D., Siegelmann-Danieli, N., & Beny, A. (2015). Resilience and psychosocial adjustment in digestive system cancer. Journal of Clinical Psychology in Medical Settings, 22(1), 1–13. https://doi.org/10.1007/s10880-015-9416-9

Government of Canada, S. C. (2017, February 8). Census Profile, 2016 Census. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/prof/index.cfm?Lang=E

Government of Canada, S. C. (2025, March 5). Health outcomes. https://www150.statcan.gc.ca/n1/pub/82-570-x/2024001/section2-eng.htm#a3_1

Graupner, C., Kimman, M. L., Mul, S., Slok, A. H. M., Claessens, D., Kleijnen, J., Dirksen, C. D., & Breukink, S. O. (2021). Patient outcomes, patient experiences and process indicators associated with the routine use of patient-reported outcome measures (PROMs) in cancer care: A systematic review. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 29(2), 573–593. https://doi.org/10.1007/s00520-020-05695-4

Groenvold, M., Fayers, P. M., Sprangers, M. A., Bjorner, J. B., Klee, M. C., Aaronson, N. K., Bech, P., & Mouridsen, H. T. (1999). Anxiety and depression in breast cancer patients at low risk of recurrence compared with the general population: A valid comparison?. Journal of Clinical Epidemiology, 52(6), 523–530. https://doi.org/10.1016/s0895-4356(99)00022-0

Hammerlid, E., & Taft, C. (2001). Health-related quality of life in long-term head and neck cancer survivors: a comparison with general population norms. British Journal of Cancer, 84(2), 149–156. https://doi.org/10.1054/bjoc.2000.1576

Hosseini, B., Nedjat, S., Zendehdel, K., Majdzadeh, R., Nourmohammadi, A., & Montazeri, A. (2017). Response shift in quality of life assessment among cancer patients: A study from Iran. Medical Journal of the Islamic Republic of Iran, 31, 120. https://doi.org/10.14196/mjiri.31.120

Hui, D., Shamieh, O., Paiva, C. E., Perez-Cruz, P. E., Kwon, J. H., Muckaden, M. A., Park, M., Yennu, S., Kang, J. H., & Bruera, E. (2015). Minimal clinically important differences in the Edmonton Symptom Assessment Scale in cancer patients: A prospective, multicenter study. Cancer, 121(17), 3027–3035. https://doi.org/10.1002/cncr.29437

Kjeldsberg, M., Tschudi-Madsen, H., Dalen, I., Straand, J., Bruusgaard, D., & Natvig, B. (2013). Symptom reporting in a general population in Norway: results from the Ullensaker study. Scandinavian Journal of Primary Health Care, 31(1), 36–42. https://doi.org/10.3109/02813432.2012.751697

Klapow, J., Kroenke, K., Horton, T., Schmidt, S., Spitzer, R., & Williams, J. B. (2002). Psychological disorders and distress in older primary care patients: A comparison of older and younger samples. Psychosomatic Medicine, 64(4), 635–643. https://doi.org/10.1097/01.psy.0000021942.35402.c3

Krabbe, P. F., Tromp, N., Ruers, T. J., & van Riel, P. L. (2011). Are patients’ judgments of health status really different from the general population?. Health and Quality of Life Outcomes, 9, 31. https://doi.org/10.1186/1477-7525-9-31

Lewis, F. M. (1986). The impact of cancer on the family: A critical analysis of the research literature. Patient Education and Counseling, 8(3), 269–289. https://doi.org/10.1016/0738-3991(86)90005-4

Manjelievskaia, J., Brown, D., McGlynn, K. A., Anderson, W., Shriver, C. D., & Zhu, K. (2017). Chemotherapy use and survival among young and middle-aged patients with colon cancer. JAMA Surgery, 152(5), 452–459. https://doi.org/10.1001/jamasurg.2016.5050

Nekolaichuk, C. L., Bruera, E., Spachynski, K., MacEachern, T., Hanson, J., & Maguire, T. O. (1999). A comparison of patient and proxy symptom assessments in advanced cancer patients. Palliative Medicine, 13(4), 311–323. https://doi.org/10.1191/026921699675854885

Noel, C. W., Sutradhar, R., Zhao, H., Delibasic, V., Forner, D., Irish, J. C., Kim, J., Husain, Z., Mahar, A., Karam, I., Enepekides, D. J., Chan, K. K. W., Singh, S., Hallet, J., Coburn, N. G., & Eskander, A. (2021). Patient-reported symptom burden as a predictor of emergency department use and unplanned hospitalization in head and neck cancer: A longitudinal population-based study. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 39(6), 675–684. https://doi.org/10.1200/JCO.20.01845

Oldenmenger, W. H., de Raaf, P. J., de Klerk, C., & van der Rijt, C. C. (2013). Cut points on 0-10 numeric rating scales for symptoms included in the Edmonton Symptom Assessment Scale in cancer patients: A systematic review. Journal of Pain and Symptom Management, 45(6), 1083–1093. https://doi.org/10.1016/j.jpainsymman.2012.06.007

Paice J. A. (2004). Assessment of symptom clusters in people with cancer. Journal of the National Cancer Institute. Monographs, (32), 98–102. https://doi.org/10.1093/jncimonographs/lgh009

Parkes C. M. (1975). The emotional impact of cancer on patients and their families. The Journal of Laryngology and Otology, 89(12), 1271–1279. https://doi.org/10.1017/s0022215100081627

Pereira, J. L., Chasen, M. R., Molloy, S., Amernic, H., Brundage, M. D., Green, E., Kurkjian, S., Krzyzanowska, M. K., Mahase, W., Shabestari, O., Tabing, R., & Klinger, C. A. (2016). Cancer care professionals’ attitudes toward systematic standardized symptom assessment and the Edmonton Symptom Assessment System after large-scale population-based implementation in Ontario, Canada. Journal of Pain and Symptom Management, 51(4), 662–672.e8. https://doi.org/10.1016/j.jpainsymman.2015.11.023

Portz, J. D., Kutner, J. S., Blatchford, P. J., & Ritchie, C. S. (2017). High symptom burden and low functional status in the setting of multimorbidity. Journal of the American Geriatrics Society, 65(10), 2285–2289. https://doi.org/10.1111/jgs.15045

Quinten, C., Coens, C., Ghislain, I., Zikos, E., Sprangers, M. A., Ringash, J., Martinelli, F., Ediebah, D. E., Maringwa, J., Reeve, B. B., Greimel, E., King, M. T., Bjordal, K., Flechtner, H. H., Schmucker-Von Koch, J., Taphoorn, M. J., Weis, J., Wildiers, H., Velikova, G., Bottomley, A., … EORTC Clinical Groups. (2015). The effects of age on health-related quality of life in cancer populations: A pooled analysis of randomized controlled trials using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 involving 6024 cancer patients. European Journal of Cancer (Oxford, England: 1990), 51(18), 2808–2819. https://doi.org/10.1016/j.ejca.2015.08.027

Ring, L., Höfer, S., Heuston, F., Harris, D., & O’Boyle, C. A. (2005). Response shift masks the treatment impact on patient reported outcomes (PROs): The example of individual quality of life in edentulous patients. Health and Quality of Life Outcomes, 3, 55. https://doi.org/10.1186/1477-7525-3-55

Ruland, C. M., Holte, H. H., Røislien, J., Heaven, C., Hamilton, G. A., Kristiansen, J., Sandbaek, H., Kvaløy, S. O., Hasund, L., & Ellison, M. C. (2010). Effects of a computer-supported interactive tailored patient assessment tool on patient care, symptom distress, and patients’ need for symptom management support: A randomized clinical trial. Journal of the American Medical Informatics Association: JAMIA, 17(4), 403–410. https://doi.org/10.1136/jamia.2010.005660

Schwartz, C. E., & Sprangers, M. A. (1999). Methodological approaches for assessing response shift in longitudinal health-related quality-of-life research. Social Science & Medicine (1982), 48(11), 1531–1548. https://doi.org/10.1016/s0277-9536(99)00047-7

Seiler, A., & Jenewein, J. (2019). Resilience in cancer patients. Frontiers in Psychiatry, 10, 208. https://doi.org/10.3389/fpsyt.2019.00208

Selby, D., Cascella, A., Gardiner, K., Do, R., Moravan, V., Myers, J., & Chow, E. (2010). A single set of numerical cutpoints to define moderate and severe symptoms for the Edmonton Symptom Assessment System. Journal of Pain and Symptom Management, 39(2), 241–249. https://doi.org/10.1016/j.jpainsymman.2009.06.010

Sharma, H. (2021). Statistical significance or clinical significance? A researcher’s dilemma for appropriate interpretation of research results. Saudi Journal of Anaesthesia, 15(4), 431. https://doi.org/10.4103/sja.sja_158_21

Sprangers, M. A., & Schwartz, C. E. (1999a). Integrating response shift into health-related quality of life research: A theoretical model. Social Science & Medicine (1982), 48(11), 1507–1515. https://doi.org/10.1016/s0277-9536(99)00045-3

Sprangers, M. A., & Schwartz, C. E. (1999). The challenge of response shift for quality-of-life-based clinical oncology research. Annals of Oncology: Official Journal of the European Society for Medical Oncology, 10(7), 747–749. https://doi.org/10.1023/a:1008305523548

Strömgren, A. S., Groenvold, M., Sorensen, A., & Sandersen, L. (2021). Symptom recognition in advanced cancer. A comparison of nursing records against patient self-rating. Acta Anaesthesiologica Scandinavica, 45(9), 1080–1085. https://doi.org/10.1034/j.1399-6576.2001.450905.x

Sutradhar, R., Rostami, M., & Barbera, L. (2019). Patient-reported symptoms improve performance of risk prediction models for emergency department visits among patients with cancer: A population-wide study in Ontario using administrative data. Journal of Pain and Symptom Management, 58(5), 745–755. https://doi.org/10.1016/j.jpainsymman.2019.07.007

Tagay, S., Herpertz, S., Langkafel, M., Erim, Y., Bockisch, A., Senf, W., & Görges, R. (2006). Health-related Quality of Life, depression and anxiety in thyroid cancer patients. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 15(4), 695–703. https://doi.org/10.1007/s11136-005-3689-7

Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and Transformation. SAGE.

Terret, C., Zulian, G. B., Naiem, A., & Albrand, G. (2007). Multidisciplinary Approach to the geriatric oncology patient. Journal of Clinical Oncology, 25(14), 1876–1881. https://doi.org/10.1200/JCO.2006.10.3291

Vanier, A., Oort, F. J., McClimans, L., Ow, N., Gulek, B. G., Böhnke, J. R., Sprangers, M., Sébille, V., Mayo, N., & Response Shift - in Sync Working Group. (2021). Response shift in patient-reported outcomes: Definition, theory, and a revised model. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. https://doi.org/10.1007/s11136-021-02846-w

van Spijker, A., Trijsburg, R. W., & Duivenvoorden, H. J. (1997). Psychological sequelae of cancer diagnosis: A meta-analytical review of 58 studies after 1980. Psychosomatic Medicine, 59(3), 280.

Visser, M. R. M., Oort, F. J., van Lanschot, J. J. B., van der Velden, J., Kloek, J. J., Gouma, D. J., Schwartz, C. E., & Sprangers, M. A. G. (2013). The role of recalibration response shift in explaining bodily pain in cancer patients undergoing invasive surgery: An empirical investigation of the Sprangers and Schwartz model. Psycho-Oncology, 22(3), 515–522. https://doi.org/10.1002/pon.2114

Zeidman, A., Benedict, C., Zion, S. R., Fisher, S., Tolby, L., Kurian, A. W., Berek, J. S., Woldeamanuel, Y. W., Schapira, L., & Palesh, O. (2022). Association of illness mindsets with health-related quality of life in cancer survivors. Health Psychology, 41(6), 389–395. https://doi.org/10.1037/hea0001186

Zion, S. R., Schapira, L., & Crum, A. J. (2019). Targeting mindsets, not just tumors. Trends in Cancer, 5(10), 573–576. https://doi.org/10.1016/j.trecan.2019.08.001


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