Background & Aims
Depression is prevalent in cancer patients, impacting quality of life, treatment adherence, and overall survival. The Edmonton Symptom Assessment System (ESAS) evaluates cancer-related symptoms, including depression, through items like pain, nausea, and anxiety. ESAS, especially the depression item (ESAS-D), has shown promise in detecting Major Depressive Disorder (MDD) in those with cancer pain, aligning with DSM-5.
The Montgomery–Asberg Depression Rating Scale (MADRS) is a standard tool for psychiatrists to assess MDD severity in psychiatric clinics. However, its applicability is limited in the context of depressive cancer pain, marked by diverse symptoms and functional decline. This study aimed to assess depression severity in cancer patients by examining ESAS-D’s validity in monitoring MDD and find the cutoff point of ESAS-D according to MADRS.
Methods
After approval from The Siriraj Institutional Review Board (Si 276/2018), we conducted a cross-sectional study with 49 individuals (aged 18 or older) experiencing cancer pain at a Thai tertiary hospital pain clinic. Participants completed the Edmonton Symptom Assessment System Depression Item (ESAS-D) questionnaire. Exclusion criteria included those unable to communicate in Thai or comprehend study materials, especially those with severe cognitive impairments.
Within two weeks, a psychiatrist conducted interviews using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the Montgomery–Asberg Depression Rating Scale (MADRS). These assessments determined Major Depressive Disorder (MDD) presence and severity. The diagnostic process aimed to identify an ESAS-D cutoff, achieving optimal sensitivity and specificity for MDD severity.
Results
49 participants provided complete data. Of these, 20 participants were identified by the study psychiatrist as meeting DSM-5 criteria for having an MDD. Our findings indicate that an ESAS-D score ?3 demonstrates a balance between sensitivity (80.9%) and specificity (82.1%) for identifying moderate depression on the MADRS. An ESAS-D score ? 5 exhibits a sensitivity of 100.0% and specificity of 73.9% for severe depression on the MADRS.
Conclusions
The Edmonton Symptom Assessment System Depression Item (ESAS-D) cutoffs of ? 3 and ? 5 demonstrate acceptable levels of sensitivity and specificity for monitoring moderate and severe MDD in individuals with cancer pain. These thresholds could prove valuable in guiding the management of depression within the cancer pain population.
References
1. Riedl D, Schuessler G. Prevalence of Depression and Cancer–A systematic review. Zeitschrift für Psychosomatische Medizin und Psychotherapie. 2021;67:OA11.
2. Edition F. Diagnostic and statistical manual of mental disorders. Am Psychiatric Assoc. 2013;21:591-643.
3. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382-9.
Kongsakon R, Zartrugpak S, Rotjananirunkit A, Buranapichet U. The reliability and validity of the Thai version of Montgomery Asberg Depression Rating Scale (MADRS). J Psychiatr Assoc Thai. 2003;48:211-9.
4. Boonyathee S, Nagaviroj K, Anothaisintawee T. The Accuracy of the Edmonton Symptom Assessment System for the Assessment of Depression in Patients With Cancer: A Systematic Review and Meta-Analysis. The American journal of hospice & palliative care. 2018;35(4):731-9.
5. Wangnamthip S, Benjangkhaprasert N, Tip-Apakoon I, Saisavoey N, Euasobhon P, Jensen MP. The validity of the Edmonton Symptom Assessment System-Depression item for screening for depression in individuals with cancer pain: A cross-sectional study. Palliat Support Care. 2023 Aug 22:1-8. .
Presenting Author
Suratsawadee Wangnamthip
Poster Authors
Suratsawadee Wangnamthip
MD
Siriraj Hospital
Lead Author
Nattha Saisavoey and MD
Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Lead Author
Natinee Benjangkhaprasert and MD
Ramadhibodi Chakri Naruebodindra Hospital, Faculty of Medicine Ramathibodi Hospital, Mahidol Univers
Lead Author
Isaraporn Tip-Apakoon and BNS
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Lead Author
Pramote Euasobhon and MD
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Cancer Pain & Palliative Care