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A comprehensive study of psychometric properties of the Edmonton Symptom Assessment System (ESAS) in Spanish advanced cancer patients

Carvajal, Ana; Centeno, Carlos; Watson, Roger; Bruera, Eduardo


Ana Carvajal

Carlos Centeno

Eduardo Bruera


Background: The Edmonton Symptom Assessment System (ESAS) is developed for daily symptom assessment. Validation studies tested a variety of languages and patients. The purpose was to carry out a comprehensive examination of the psychometric properties of the ESAS through validation of the version in Spanish advanced cancer patients. Method: A reverse translation method was used to translate the ESAS. Previous studies find appropriate Spanish terms to explore, with verbal scales, fatigue, depression and anxiety. Psychometric aspects evaluated were reliability, validity, responsiveness and utility. Results: 171 advanced cancer patients participated. Internal consistency with Cronbach's Alpha was 0.75. In test-retest (0-6 h), Spearma's correlation was between 0.65 and 0.94. Factor analysis found 3 central domains: 'soft' and 'hard physical' and 'emotional'. Concurrent validity with the Rotterdam Symptom Check List (RSCL) found good correlation in physical symptoms (Kappa until 0.66) but weak correlation in emotional symptoms (Kappa 0.35). Discriminant validity (Spearman) found significant differences (p < 0.001) classifying by Karnofsky. ESAS discriminate between inpatients and outpatients (Mann-Whitney, p < 0.001). Responsiveness was tested with ESAS at 0-48 h (Wilcoxon test, p < 0.05). Average time to complete the instrument was 5.5 min. Conclusion: ESAS is a valid, reliable, responsive and feasible instrument with adequate psychometric properties when tested on Spanish advanced cancer patients. © 2011 Elsevier Ltd. All rights reserved.


Carvajal, A., Centeno, C., Watson, R., & Bruera, E. (2011). A comprehensive study of psychometric properties of the Edmonton Symptom Assessment System (ESAS) in Spanish advanced cancer patients. European Journal of Cancer, 47(12), 1863-1872.

Journal Article Type Article
Acceptance Date Mar 23, 2011
Online Publication Date Apr 22, 2011
Publication Date 2011-08
Deposit Date Nov 13, 2014
Journal European Journal Of Cancer
Print ISSN 1879-0852
Electronic ISSN 1879-0852
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 47
Issue 12
Pages 1863-1872
Keywords Symptom assessment tool; ESAS; Advanced cancer patients; Palliative care; Translation process; Validity; Reliability; Responsiveness; Utility;
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