Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
Eur J Cancer Care (Engl). 2013 Jan;22(1):60-9. doi: 10.1111/j.1365-2354.2012.01369.x. Epub 2012 Jun 14.
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.
埃德蒙顿症状评估系统（ESAS）是癌症中常用的筛查工具，但其用于筛查苦恼的有效性尚未得到证实。在这里，ESAS 焦虑（ESAS-A）和抑郁（ESAS-D）项目的筛查性能通过 PHQ 的焦虑[广泛性焦虑障碍-7（GAD-7）]和抑郁[患者健康问卷-9（PHQ-9）]子量表进行了验证。共有 1215 名癌症患者完成了计算机化的痛苦筛查工具 DART（痛苦评估和反应工具）。使用 Spearman 等级相关系数和受试者工作特征曲线分析来评估 ESAS-A 和 ESAS-D 识别中度痛苦（GAD-7/PHQ-9≥10）的能力。ESAS-A 和 ESAS-D 与 GAD-7 和 PHQ-9 的 Spearman 等级相关系数分别为 0.74 和 0.72。焦虑和抑郁的受试者工作特征曲线下面积分别为 0.89 和 0.88。ESAS-A 的≥3 切点显示出 0.91 的敏感性、0.68 的特异性、0.34 的阳性预测值和 0.97 的阴性预测值。ESAS-D 的≥2 切点显示出 0.86 的敏感性、0.72 的特异性、0.46 的阳性预测值和 0.95 的阴性预测值。ESAS-A 和 ESAS-D 在某些切点的高敏感性表明它们在排除痛苦方面具有一定的作用。然而，它们的低特异性表明需要进行二级筛查以确认焦虑或抑郁的存在，以便进行病例发现。
