Definition: Proportion of patient self-assessments (ESAS-r) reporting no distress, low distress, moderate distress or high distress respectively by specific symptoms (i.e., pain, fatigue, anxiety and depression)
Rationale for measurement: Routine screening of symptoms is important to identify cancer patients’ psychological, social, spiritual, practical or physical concerns that may negatively affect a person’s ability to cope with cancer and its treatment. One common self-report tool used to measure patient-reported outcomes is the Edmonton Symptom Assessment System (ESAS), which measures nine commonly reported symptoms (pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, lack of well-being and shortness of breath).
Measurement timeframe: 1 October 2016 – 31 March 2017
Denominator: Total number of questionnaires completed
Numerator: Number of questionnaires reporting the level of distress by:
- no distress
- low
- moderate
- high level
Exclusion criteria:
- Questionnaires with patients aged <18 were excluded
- Questionnaires with patients diagnosed with benign hematologic diseases were excluded
- Questionnaires with no response to each symptom and level of score were excluded respectively
Data availability: AB, SK, MB, ON, QC, NS, PE
Stratification: Data were pooled together by four symptoms of distress:
- pain
- fatigue
- anxiety
- depression
Data source: Patient-Reported Outcome (PRO) Initiative partners
Data retrieval date: October 2017
Variables details: The questions on symptoms of distress varied by province. For each province, relevant questions were identified and included in the analysis.
Notes from jurisdictions:
- MB: Patients are screened for distress at every physician visit which includes new, on treatment and follow-up appointments. Inclusions: 1. Patient age ≥ 18 2. All cancers with the exception of Head and Neck cancer (including metastatic cases and benign hematological cases).
- NS: We have defined Positive for Distress on this indicator as a score from 1-10 on the Distress Thermometer (DT). As noted above, 74.9% of patients who completed the DT from October 2016-March 2017, indicated some level of distress. We do not have the ability to report on this indicator (i.e., number of questionnaires positive for distress as defined by score of 1-10 for any symptom) on the ESAS-r at present. The denominator for this Indicator is different than the denominator for Indicator 2 because not all patients completed the Distress Thermometer on our Screening Tool (which consists of DT, CPC, and ESAS-r). There were 101 patients who completed the Screening Tool, but chose not to complete the Distress Thermometer item on the tool.
- ON: All field on ESAS are mandatory using the ISAAC data capture system, so it is assumed that there are zero “no responses”. Any discrepancies are likely due to patients not completing all questions when completing ESAS via paper.
Methodology notes:
- Data came from partners that participated in the Patient Reported Outcome (PRO) initiative survey
- Edmonton Symptom Assessment System-revised (ESAS-r), a self-assessment tool, was used to collect common symptoms in cancer patients during their treatment.
- Respondents scored the degree of symptoms using a scale of 0–10. These responses were grouped into four categories:
- No distress: score 0
- Low: scores 1–3
- Moderate: scores 4–6
- High: scores 7–10
- Each symptom has a small number of no responses that are excluded: pain, 0.5%; fatigue, 0.4%; anxiety, 0.5%; depression, 0.5%.
Changes to definition compared to previous years: Not applicable
