The Edmonton Symptom Assessment System: A narrative review of a standardized symptom assessment tool in head and neck oncology

Objective: Symptom burden is common in head and neck cancer patients though it frequently remains undetected and untreated. The Edmonton Symptom Assessment System -revised version (ESAS-r) is a generic symptom scale deployed in many outpatient settings worldwide. The ESAS-r is meant to improve symptom detection and management. We sought to review the ESAS-r and its psychometric properties in a head and neck oncology population. Methods: Narrative Review. Results: Over the past 30 years, the ESAS-r has emerged as one of the most used symptom scales for cancer patients. Its psychometric properties in a heterogenous cancer population are well supported, proving to be reliable and valid in a variety of settings. The linking of ESAS-r scores with Ontario administrative health data has led to a detailed assessment of validity in head and neck cancer. The ESAS-r can discriminate between high and low levels of symptom burden and is responsive to change over time in this patient population. ESAS-r scores have also been shown to be a strong predictor of future emergency department use and unplanned hospitalization in head and neck cancer patients. Conclusions: The ESAS-r is reliable and valid in the head and neck cancer population and may serve as a useful clinical endpoint in research studies.

Automated summary

The ESAS-r has become one of the most widely used symptom scales for cancer patients over the past 30 years, with well-supported psychometric properties in a heterogenous cancer population, proving to be reliable and valid in various settings. Linking ESAS-r scores with Ontario administrative health data has allowed for a detailed assessment of validity in head and neck cancer. The ESAS-r can distinguish between high and low levels of symptom burden, showcasing responsiveness to changes over time in this patient population. ESAS-r scores have also demonstrated to be a strong predictor of future emergency department use and unplanned hospitalization in head and neck cancer patients.