title: The Edmonton Symptom Assessment System (ESAS) as a screening tool for depression and anxiety in non-advanced patients with solid or haematological malignancies on cure or follow-up.
abstract: BACKGROUND
  Symptoms' assessment should be considered a clinical practice routine in all cancer stages. The Edmonton Symptom Assessment System (ESAS) is a ten-item patient-rated symptom assessment developed and validated for population affected by cancer in different languages and cultures. The main objective of this study was to assess the performance of ESAS items on anxiety and depression when detecting Hospital Anxiety Depression Scale (HADS) 'cases'.
  
  
  METHODS
  A cross-sectional study was carried out on 194 non-advanced patients with solid (108) or hematologic malignancies on cure or follow up, Karnofsky Performance Status ≥ 70, life expectancy > 6 months and no metastases. Patients were assessed by means of ESAS and by HADS. Receiving operator characteristic (ROC) analysis of ESAS anxiety and depression items versus cases of severe (cutoff 11) anxiety and depression according to HADS-specific subscales was performed.
  
  
  RESULTS
  Depression and anxiety ESAS items correlated strongly (0.707, Spearman). Area under the curve ranged between 0.84 and 0.96 for the two ESAS items when detecting severe anxiety or depression HADS cases (cutoff = 11). ESAS anxiety or depression scores >3 detected quite well the severe depression HADS cases (Sensibility = 75-Specificity = 84, Sensibility = 87-Specificity = 90, respectively).
  
  
  CONCLUSIONS
  Anxiety or depression ESAS items score >3 can be applied as a useful, easy and not time consuming screening tool for assessing anxiety and depression in non-advanced patients with solid or haematological malignancies.
authors.affiliation: Department of Hematology and Pediatric Onco-Hematology, Supportive Care in Cancer Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy, carla.ripamonti@istitutotumori.mi.it.
authors.forename: Carla I
authors.initials: CI
authors.lastname: Ripamonti
authors.forename: Elena
authors.initials: E
authors.lastname: Bandieri
authors.forename: Maria Adelaide
authors.initials: MA
authors.lastname: Pessi
authors.forename: Alice
authors.initials: A
authors.lastname: Maruelli
authors.forename: Loredana
authors.initials: L
authors.lastname: Buonaccorso
authors.forename: Guido
authors.initials: G
authors.lastname: Miccinesi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology*; D063189:Symptom Assessment / Q000379:methods*