Validation of the numerical rating scale versions of the Edmonton Symptom Assessment Aystem (ESAS) and ESAS-r among outpatients with advanced cancer.
Bibliographic record
Abstract
e20638 Background: The ESAS is usually presented as a numerical rating scale (NRS); but has been validated for outpatients with cancer only as a visual analogue scale. We aimed to validate the NRS versions of ESAS and ESAS-r, and to assess patient preference for either version. Methods: Patients with advanced cancer (N=202) attending ambulatory palliative care clinics at the Princess Margaret Cancer Centre, Toronto, between February 2012 and January 2013, completed both the conventional ESAS, with an added time window of “past 24 hours”, and the ESAS-r, which includes a time window of ”now” and symptom definitions. Participants completed the Memorial Symptom Assessment Scale (MSAS) and a patient-rated version of the Eastern Cooperative Oncology Group (ECOG) performance status measure. Physicians rated the ECOG independently. At 24 hours, 26 patients completed a test-retest study. Results: ESAS and ESAS-r total distress scores both correlated well with total MSAS scores (Spearman’s rho: 0.62 and 0.64, respectively). Correlation of individual ESAS symptoms with MSAS symptoms are shown in the Table, as are correlations of the overall ESAS scores with physician and patient-rated ECOG. Participants preferred the ESAS-r (42.8% versus 18.6%), finding the definitions helpful (87.1%), but preferred the time window of “past 24 hours” (52.8%) over “now” (21.3%). The 24 hour test-retest evaluation of the ESAS showed good correlation (ICC = 0.74). Conclusions: The ESAS and ESAS-r NRS versions are valid and reliable for outpatients with advanced cancer. The 24 hour time window was preferred and may best capture fluctuating symptoms (e.g. nausea, shortness of breath) in this population. Correlations of ESAS scores/subscores with validation measures. Measure ESAS score/subscore ESAS ESAS-r Patient completed ECOG, N (r) EDS 193 (0.40) 192 (0.33) Physician completed ECOG, N (r) EDS 173 (0.35) 172 (0.24) MSAS Pain * 0.68 0.66 Lack of energy Tiredness 0.58 0.52 Nervous Anxiety 0.57 0.59 Nausea * 0.72 0.64 Drowsiness * 0.66 0.61 Shortness of breath * 0.80 0.74 Sad Depression 0.66 0.64 Worry Anxiety 0.64 0.65 Appetite * 0.63 0.73 *same item name for ESAS; EDS, ESAS distress score.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.023 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".