Minimal Clinically Important Differences in the Edmonton Symptom Assessment System in Patients With Advanced Cancer

• Published in: Journal of pain and symptom management Vol. 46; no. 2; pp. 192 - 200
• Main Authors: Bedard, Gillian, BSc (C), Zeng, Liang, MD (C), Zhang, Liying, PhD, Lauzon, Natalie, MRT (T), Holden, Lori, MRT (T), Tsao, May, MD, Danjoux, Cyril, MD, Barnes, Elizabeth, MD, Sahgal, Arjun, MD, Poon, Michael, BSc (C), Chow, Edward, MBBS, MSc, PhD, FRCPC
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2013; Elsevier
• Subjects: Adult; advanced cancer; Aged; Aged, 80 and over; Anesthesia & Perioperative Care; Anxiety - diagnosis; Anxiety - epidemiology; Anxiety-Depression; Biological and medical sciences; Cancer; Causality; Comorbidity; Edmonton Symptom Assessment System; Fatigue - diagnosis; Fatigue - epidemiology; Female; Humans; Longitudinal Studies; Male; Medical sciences; Middle Aged; Minimal clinically important difference; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasms - diagnosis; Neoplasms - epidemiology; Neoplasms - radiotherapy; Ontario - epidemiology; Pain; Pain - diagnosis; Pain - epidemiology; Pain Medicine; Palliative care; Patient Outcome Assessment; Pharmacology. Drug treatments; Prevalence; Quality of Life; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Severity of Illness Index; Surveys and Questionnaires; Symptoms; Terminally ill people; Tumors; Ontario; advanced cancer; palliative care; Minimal clinically important difference; Edmonton Symptom Assessment System; Human; Evaluation; Symptomatology; Palliative care; Advanced stage; Malignant tumor; Cancer
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2012.07.022

Abstract Context Longitudinal symptom monitoring is important in the setting of patients with advanced cancer. Scores over time may naturally fluctuate, although a patient may feel the same. Objectives The purpose of this study was to determine the minimal levels of change required to be clinically relevant (minimal clinically important difference [MCID]) using the Edmonton Symptom Assessment System (ESAS). Methods Between 1999 and 2009, patients completed the ESAS before palliative radiotherapy and at follow-up. MCIDs were calculated using both the anchor- and distribution-based methods for improvement and deterioration; 95% confidence intervals for the differences in mean change scores between adjacent categories also were calculated. Results A total of 276 patients completed the ESAS at baseline and during at least one follow-up visit. At the four-week follow-up, decrease of 1.2 and 1.1 units in pain and depression scales, respectively, constituted clinically relevant improvement, whereas increase of at least 1.4, 1.8, 1.1, 1.1, and 1.4 units, respectively, in pain, tiredness, depression, anxiety, and appetite loss items were required for deterioration. At the subsequent follow-ups, these values were similar. Overall, the MCID for improvement tended to be smaller than that for deterioration. The distribution-based method estimates tended to be larger than the 0.3 SD estimates, but closer to the 0.5 SD estimates. Conclusion MCIDs allow health care professionals to determine the success of treatment in improving the patient's quality of life. MCIDs may prompt health care professionals to intervene with new treatment. Future studies should confirm our findings with a variety of anchors.