title: Establishing Cutoff Points for Defining Symptom Severity Using the Edmonton Symptom Assessment System-Revised Japanese Version.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Department of Psychooncology, National Cancer Center East Hospital, Kashiwa, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nitto
authors.affiliation: Department of Palliative Care, Japanese Red Cross Medical Center, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Department of Oncology, Japanese Red Cross Medical Center, Tokyo, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: Department of Anesthesiology and Intensive Care 2, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishie
authors.affiliation: Department of Palliative Care, Okayama University Hospital, Okayama, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Matsuoka
authors.affiliation: Department of Palliative Care, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakurai
authors.affiliation: Department of Palliative Care, Okayama Saiseikai General Hospital, Okayama, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Ishihara
authors.affiliation: Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Tarumi
authors.affiliation: Department of Psychooncology, National Cancer Center East Hospital, Kashiwa, Japan. Electronic address: aaogawa@ya2.so-net.ne.jp.
authors.forename: Asao
authors.initials: A
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D012016:Reference Values; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D063189:Symptom Assessment / Q000379:methods*; D014175:Translating; D014177:Translations
keywords: Edmonton Symptom Assessment System; cancer; cutoff point; depression; symptom severity