Establishing Cutoff Points for Defining Symptom Severity Using the Edmonton Symptom Assessment System-Revised Japanese Version

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• 作者：Takashi Yamaguchi ; MD ; PhD^a ; Tatsuya Morita ; MD^b ; Akihiro Nitto ; MA^c ; Naoko Takahashi ; MD^d ; Shingo Miyamoto ; MD^e ; Hiroyuki Nishie ; MD^f ; Junji Matsuoka ; MD ; PhD^g ; Hiroki Sakurai ; MD^h ; Tatsuhiko Ishihara ; MDⁱ ; Yoko Tarumi ; MD^j ; Asao Ogawa ; MD ; PhD^c ; ^{aaogawa@ya2.so-net.ne.jp" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Edmonton Symptom Assessment System ; cutoff point ; symptom severity ; depression ; cancer
• 刊名：Journal of Pain and Symptom Management
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：51
• 期：2
• 页码：292-297
• 全文大小：119 K

文摘

Symptom screening is important for appropriate symptom management. It remains uncertain as to which scores on the Edmonton Symptom Assessment System-Revised (ESAS-r) comprise the optimal cutoff points to determine symptom severity for Japanese cancer patients.

Objectives

To investigate optimal cutoff points for individual ESAS-r items for detecting symptom severity and to evaluate the screening performance of the ESAS-r depression item in Japanese cancer patients.

Methods

We recruited cancer patients receiving palliative care from five tertiary acute hospitals in Japan. We asked participants to complete the ESAS-r Japanese version, Verbal Rating Symptom Severity Scale, and Quick Inventory of Depressive Symptomatology-Self-Report Japanese version. We calculated sensitivity and specificity for detecting severe and moderate/severe symptoms evaluated by the Verbal Rating Symptom Severity Scale at different cutoff points of the ESAS-r. We also calculated sensitivity and specificity for detecting both the presence of depression and moderate/severe depression evaluated by the Quick Inventory of Depressive Symptomatology-Self-Report at various cutoff points for the depression item of the ESAS-r Japanese version.

Results

A total of 292 participants completed the questionnaire. For most of the ESAS-r symptoms, cutoff points to achieve the best balance between sensitivity and specificity were 5–7 for determining severe intensity and 3–4 for determining moderate/severe intensity. For the ESAS-r depression item, a cutoff point of 2 achieved the best balance between sensitivity and specificity for detecting both the presence of depression and moderate/severe depression.

Conclusion

The ESAS-r Japanese version can accurately represent the severity of many symptoms. The cutoff points established for determining the level of symptom severity using ESAS-r provides a guide for symptom management in Japanese cancer patients.