title: Does routine symptom screening with ESAS decrease ED visits in breast cancer patients undergoing adjuvant chemotherapy?
abstract: BACKGROUND
  In 2007, the provincial cancer agency in Ontario, Canada initiated a wide-scale program to screen for symptoms in the cancer population using the Edmonton Symptom Assessment Scale (ESAS). The purpose of this study is to evaluate the impact of screening with ESAS on emergency department (ED) visit rates in women with breast cancer receiving adjuvant chemotherapy.
  
  
  METHODS
  This retrospective cohort study used linked administrative health care data from across the province of Ontario, Canada. The cohort included all women aged ≥18 who were diagnosed with stage I-III breast cancer between January 2007 and December 2009 and received adjuvant chemotherapy within 6 months of diagnosis. Using an adjusted recurrent event model, we examined the association of screening with ESAS at a clinic visit on the ED visit rate.
  
  
  RESULTS
  The relative rate of ED visits was 0.57 when prior ESAS screening occurred compared to when it did not. The relative rate of ED visits was 0.83 when the prior number of ESAS screens was modeled as a continuous variable. Alternatively stated, the rate of ED visits was 43 % lower among patients previously screened with ESAS compared to those not previously screened. For each additional prior ESAS assessment, there was a 17 % decreased rate of ED visits.
  
  
  CONCLUSIONS
  Our results demonstrate that screening with ESAS is associated with decreased ED visits. To our knowledge, this is the first report on the effectiveness of routinely documenting a patient reported outcome on ED visits, in a real-world setting.
authors.affiliation: Odette Cancer Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada, lisa.barbera@sunnybrook.ca.
authors.forename: L
authors.initials: L
authors.lastname: Barbera
authors.forename: R
authors.initials: R
authors.lastname: Sutradhar
authors.forename: D
authors.initials: D
authors.lastname: Howell
authors.forename: J
authors.initials: J
authors.lastname: Sussman
authors.forename: H
authors.initials: H
authors.lastname: Seow
authors.forename: D
authors.initials: D
authors.lastname: Dudgeon
authors.forename: C
authors.initials: C
authors.lastname: Atzema
authors.forename: C
authors.initials: C
authors.lastname: Earle
authors.forename: A
authors.initials: A
authors.lastname: Husain
authors.forename: Y
authors.initials: Y
authors.lastname: Liu
authors.forename: M K
authors.initials: MK
authors.lastname: Krzyzanowska
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000639:trends*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D055088:Early Detection of Cancer; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D063189:Symptom Assessment; D055815:Young Adult