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The impact of routine Edmonton Symptom Assessment System (ESAS) use on overall survival in cancer patients: results of a population‐based retrospective matched cohort analysis


Background — The Edmonton Symptom Assessment System (ESAS) is a validated instrument whose use has been standardized in the Ontario cancer system to measure symptoms among ambulatory cancer patients. The objective was to examine the effect of ESAS exposure on overall survival. We hypothesized, a priori, that patients exposed to ESAS would have higher rates of overall survival than those who were not exposed.

Methods — This was a retrospective matched cohort study of adults diagnosed with cancer between 2007 and 2015. Patients were considered exposed if they were screened with ESAS at least once during the study period. Their first ESAS screening date defined the index date. Each exposed patient was matched randomly to a cancer patient without ESAS using a combination of hard matching (4 variables) and propensity score matching (14 variables). Kaplan‐Meier curves and multivariable Cox regression were used to evaluate the impact of ESAS exposure on survival.

Results — There were 128,893 pairs well matched on all baseline characteristics. The probability of survival within the first 5 years was higher among those exposed to ESAS compared to those who were not (81.9% vs. 76.4% at 1 year, 68.3% vs. 66.1% at 3 years, 61.9% vs. 61.4% at 5 years, P‐value < .0001). In the multivariable Cox regression model, ESAS was significantly associated with a decreased mortality risk (HR: 0.48, 95% CI: 0.47‐0.49).

Conclusions — Our results show that ESAS exposure is associated with improved survival in cancer patients. This provides real world evidence of the impact of routine symptom assessment in cancer care.



Barbera L, Sutradhar R, Seow H, Mittmann N, Howell D, Earle CC, Li Q, Thiruchelvam D. Cancer Med. 2020; 9(19):7107-15. Epub 2020 Aug 14.

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