The utility of the Edmonton Symptom Assessment System in screening for anxiety and depression

BAGHA S.M., MACEDO A., JACKS L.M., LO C., ZIMMERMANN C., RODIN G. & LI M. (2013) European Journal of Cancer Care 22 , 60–69 The utility of the Edmonton Symptom Assessment System in screening for anxiety and depression The Edmonton Symptom Assessment System (ESAS) is a common screening tool in cancer, although its validity for distress screening is unproven. Here, screening performance of the ESAS anxiety (ESAS‐A) and depression (ESAS‐D) items were validated against the anxiety [Generalised Anxiety Disorder‐7 (GAD‐7)] and depression [Patient Health Questionnaire‐9 (PHQ‐9)] subscales of the PHQ. A total of 1215 cancer patients completed the Distress Assessment and Response Tool (DART), a computerised distress screening instrument. Spearman's rank correlation coefficients and receiver operating characteristic curve analyses were used to evaluate the ability of ESAS‐A and ESAS‐D to identify moderate distress (GAD‐7/PHQ‐9 ≥ 10). Spearman's rank correlation coefficients comparing ESAS‐A and ESAS‐D with GAD‐7 and PHQ‐9 were 0.74 and 0.72 respectively. Areas under the receiver operating characteristic curves were 0.89 and 0.88 for anxiety and depression respectively. A cut‐off of ≥3 on ESAS‐A demonstrated a sensitivity of 0.91, specificity of 0.68, positive predictive value of 0.34 and negative predictive value of 0.97. A cut‐off of ≥2 on the ESAS‐D demonstrated a sensitivity of 0.86, specificity of 0.72, positive predictive value of 0.46 and negative predictive value of 0.95. High sensitivities of ESAS‐A and ESAS‐D at certain cut‐offs suggest they have use in ruling‐out distress. However, their low specificities indicate secondary screening is needed to rule‐in anxiety or depression for case‐finding.