The Brazilian Version of the Edmonton Symptom Assessment System (ESAS) Is a Feasible, Valid and Reliable Instrument for the Measurement of Symptoms in Advanced Cancer Patients.

Carlos Eduardo Paiva,Luciana Lopes Manfredini,David Hui,Eduardo Bruera,Bianca Sakamoto Ribeiro Paiva,Ali Montazeri

doi:10.1371/journal.pone.0132073

Abstract

PurposesTo develop and validate a Portuguese version of the Edmonton Symptom Assessment System (ESAS) in Brazilian patients with advanced cancer.MethodsThe ESAS was translated and then back translated into Portuguese in accordance with international guidelines. The final version was approved by an Expert Committee after pilot testing on 24 advanced cancer patients. Subsequently, we evaluated the time to complete the assessment, the number of unanswered items, internal consistency, convergent validity, and known-group validity in a sample of 249 advanced cancer patients who completed the ESAS along with the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), Hospital Anxiety and Depression Scale (HADS), and Epworth Sleepiness Scale (ESS). A total of 90 clinically stable patients were retested after 4 to 96 hours (test-retest reliability), and 80 patients answered the ESAS after 21 (±7) days to measure scale responsiveness using an anchor-based method.ResultsThe ESAS was completed in a mean time of only 2.2 minutes. The internal consistency was good (Cronbach's alpha = 0.861), and the removal of single items did not change the overall alpha value. For convergent validity, Spearman’s correlation coefficients between the ESAS symptom scores and the corresponding EORTC QLQ-C30 and ESS symptom scores ranged between 0.520 (95% CI = 0.424–0.605) and 0.814 (95% CI = 0.760–0.856), indicating moderate to strong correlations. Test-retest reliability values were considered adequate, with intraclass correlation coefficients ranging from 0.758 (95% CI = 0.627–0.843) to 0.939 (95% CI = 0.905–0.960).ConclusionsESAS is a feasible, valid and reliable multi-symptom assessment instrument for use in Brazil.

Highlights

Patients with advanced cancer frequently report multiple concomitant symptoms [1,2] that negatively affect their quality of life [3]
The Edmonton Symptom Assessment System (ESAS) was completed in a mean time of only 2.2 minutes
Validation of the Edmonton Symptom Assessment System in Brazil scores ranged between 0.520 and 0.814, indicating moderate to strong correlations

Summary

Introduction

Patients with advanced cancer frequently report multiple concomitant symptoms [1,2] that negatively affect their quality of life [3]. The Edmonton Symptom Assessment System (ESAS) is a widely used, multiple-symptom assessment instrument that was first developed in 1991 by Bruera et al to audit the symptoms of patients receiving palliative care [8]. The ESAS investigated eight symptoms using visual analog scales (0–100 mm). These scales have undergone several changes since they were first implemented. The ESAS has been translated and validated in several languages and cultures [8,9,10,11,12,13,14,15,16] It is frequently adapted in medical practice and research in Brazil, its psychometric properties have not been formally investigated to date

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