Palliative Care Department, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada.
J Pain Symptom Manage. 2010 Feb;39(2):241-9. doi: 10.1016/j.jpainsymman.2009.06.010. Epub 2009 Dec 5.
Symptom intensity in cancer and palliative care patients is frequently assessed using a 0-10 ranking score. Results are then often grouped into verbal categories (mild, moderate, or severe) to guide therapy. Numerical cutpoints separating these categories are often variable, with previous work suggesting different cutpoints across different symptoms, which is unwieldy for clinical use. The Edmonton Symptom Assessment Symptom (ESAS) assesses nine common symptoms using this 0-10 scale. The primary aim of this study was to examine the relationship between the numerical and verbal scores using the ESAS and to identify a single cutpoint to separate severe from nonsevere symptomatology. A second goal was to similarly identify a cutpoint to separate moderate or severe from none or mild symptom intensity. Consenting patients (n=400) completed both a standard ESAS and an identical form that replaced 0-10 with none, mild, moderate, and severe. Receiver operating characteristic curves were generated to identify the best fit between sensitivity and specificity. For the "severe" ranking, six symptoms had a best fit of 7, with sensitivity for the remaining three symptoms still greater than 80%. For the combined grouping of moderate or severe, results were less uniform. A cutpoint of either 4 or 5 would be supported by our data, with a greater sensitivity using 4 and improved specificity using 5 as the cutpoint. Across all ESAS symptoms, then, 7 or higher represents a severe symptom by patient definition, whereas a cutpoint of either 4 or 5 could reasonably define combined moderate and severe symptoms.
在癌症和姑息治疗患者中，症状强度通常使用 0-10 分的评分进行评估。结果通常分为口头类别（轻度、中度或重度）以指导治疗。区分这些类别的数值切点通常是可变的，之前的工作表明不同的症状有不同的切点，这对于临床使用来说很不方便。埃德蒙顿症状评估量表（ESAS）使用这种 0-10 量表评估九种常见症状。这项研究的主要目的是检查 ESAS 中数字评分和口头评分之间的关系，并确定一个单一的切点来区分严重和非严重的症状表现。第二个目标是同样确定一个切点来区分中度或重度与无或轻度症状强度。同意参与的患者（n=400）完成了标准 ESAS 量表和一份完全相同的量表，其中用无、轻度、中度和重度替代了 0-10 分。生成了接收者操作特征曲线来确定灵敏度和特异性之间的最佳拟合。对于“严重”等级，有六个症状的最佳拟合值为 7，其余三个症状的灵敏度仍大于 80%。对于中度或重度的综合分组，结果则不那么一致。我们的数据支持 4 或 5 作为切点，使用 4 作为切点灵敏度更高，使用 5 作为切点特异性更好。那么，在所有 ESAS 症状中，7 或更高表示患者定义的严重症状，而 4 或 5 的切点可以合理地定义中度和重度的综合症状。
