The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

Abstract

ContextRoutine symptom assessment represents the cornerstone of symptom management. Edmonton Symptom Assessment System (ESAS) is one of the first quantitative symptom assessment batteries that allows for simple and rapid documentation of multiple patient-reported symptoms at the same time. ObjectivesTo discuss the historical development of ESAS, its current uses in different settings, and future developments. MethodsNarrative review. ResultsSince its development in 1991, ESAS has been psychometrically validated and translated into over 20 languages. We will discuss the variations, advantages, and limitations with ESAS. From the clinical perspective, ESAS is now commonly used for symptom screening and longitudinal monitoring in patients seen by palliative care, oncology, nephrology, and other disciplines in both inpatient and outpatient settings. From the research perspective, ESAS has offered important insights into the nature of symptom trajectory, symptom clusters, and symptom modulators. Furthermore, multiple clinical studies have incorporated ESAS as a study outcome and documented the impact of various interventions on symptom burden. On the horizon, multiple groups are actively investigating further refinements to ESAS, such as incorporating it in electronic health records, using ESAS as a trigger for palliative care referral, and coupling ESAS with personalized symptom goals to optimize symptom response assessment. ConclusionESAS has evolved over the past 25 years to become an important symptom assessment instrument in both clinical practice and research. Future efforts are needed to standardize this tool and explore its full potential to support symptom management.