title: The Edmonton Symptom Assessment System as a screening tool for depression and anxiety.
abstract: OBJECTIVE
  Mood disorders are among the most important psychiatric problems in patients with cancer. However, they are frequently underdiagnosed and therefore undertreated. This may lead to difficulties with symptom control, social withdrawal, and poor quality of life. This study was conducted to evaluate the screening performance of the Edmonton Symptom Assessment System (ESAS) for depression and anxiety, compared to Hospital Anxiety and Depression Scale (HADS).
  
  
  METHODS
  We retrospectively reviewed and analyzed ESAS and HADS data collected from three previous clinical trials conducted by our group. The diagnosis of depression and/or anxiety, and moderate/severe depression and/or anxiety made when patients scored 8 or more, and 11 or more in HADS questionnaire, respectively. The sensitivity, specificity, positive, and negative predictive values for ESAS were calculated.
  
  
  RESULTS
  Of 216 patients analyzed, the median (range) score for depression was 2 (0-10) and anxiety 3 (0-10) using ESAS, and 6 (0-16) and 7 (0-19) using HADS, respectively. A cut off of 2 out of 10 or more in the ESAS gave a sensitivity of 77% and 83% with a specificity of 55% and 47% for depression and moderate/severe depression, respectively. A cutoff of 2 out of 10 or more in the ESAS gave a sensitivity of 86% and 97%, and a specificity of 56% and 43% for anxiety and moderate/severe anxiety, respectively.
  
  
  CONCLUSIONS
  Our data suggest that the ideal cutoff point of ESAS for the screening of depression and anxiety in palliative care is 2 out of 10 or more. More research is needed to define the ideal cutoff point for screening of severe depression and anxiety.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas, MD Anderson Cancer Center, Houston, 77030, USA.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Vignaroli
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Pace
authors.forename: Jie
authors.initials: J
authors.lastname: Willey
authors.forename: J Lynn
authors.initials: JL
authors.lastname: Palmer
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis*; D002986:Clinical Trials as Topic; D003863:Depression / Q000175:diagnosis*; D019937:Diagnostic Techniques and Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies