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
Open accessAbstract
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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Remote patient monitoring (RPM) of symptoms using electronic patient reported outcomes (ePROs) reduces symptom burden during systemic cancer therapy.
“Remote patient monitoring (RPM) of symptoms using electronic patient reported outcomes (ePROs) has been shown to reduce symptom burden and hospitalizations, increase dose intensity and improve quality of life of patients during systemic therapy being recommended by international guidelines in routine oncology practice.”
From Implementation of a remote symptom monitoring pathway in oncology care: analysis of real-world experience across 33 cancer centres in France and Belgium (2024) · cites this paper as [11]
The Introduction describes routine patient-reported symptom monitoring, and the Methods describe electronic ESAS assessments at clinic kiosks. The Discussion reports a survival association and suggests improved symptom management as a possible mechanism, but it does not show that remote ePRO monitoring reduced symptom burden during systemic therapy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredRemote patient monitoring (RPM) of symptoms using electronic patient reported outcomes (ePROs) improves quality of life during systemic cancer therapy.
“Remote patient monitoring (RPM) of symptoms using electronic patient reported outcomes (ePROs) has been shown to reduce symptom burden and hospitalizations, increase dose intensity and improve quality of life of patients during systemic therapy being recommended by international guidelines in routine oncology practice.”
From Implementation of a remote symptom monitoring pathway in oncology care: analysis of real-world experience across 33 cancer centres in France and Belgium (2024) · cites this paper as [11]
The Introduction (page not provided) says that routine use of patient-reported outcomes in cancer care can improve quality of life. It does not establish that remote electronic symptom monitoring improves quality of life specifically during systemic therapy. The Methods describe ESAS assessments captured at clinic kiosks, and the paper’s own outcome is survival, not quality of life. (LLM, conf=0.86)
Experimental — accuracy not yet measuredRemote patient monitoring (RPM) of symptoms using electronic patient reported outcomes (ePROs) increases dose intensity during systemic cancer therapy.
“Remote patient monitoring (RPM) of symptoms using electronic patient reported outcomes (ePROs) has been shown to reduce symptom burden and hospitalizations, increase dose intensity and improve quality of life of patients during systemic therapy being recommended by international guidelines in routine oncology practice.”
From Implementation of a remote symptom monitoring pathway in oncology care: analysis of real-world experience across 33 cancer centres in France and Belgium (2024) · cites this paper as [11]
The Discussion suggests that better symptom management may have allowed patients to stay on chemotherapy longer. It presents this as a possible explanation for the observed survival association, not as a measured increase in dose intensity during systemic therapy. The Methods describe in-clinic touchscreen ESAS assessments, rather than remote monitoring. (LLM, conf=0.82)
Experimental — accuracy not yet measuredRemote patient monitoring (RPM) of symptoms using electronic patient reported outcomes (ePROs) reduces hospitalizations during systemic cancer therapy.
“Remote patient monitoring (RPM) of symptoms using electronic patient reported outcomes (ePROs) has been shown to reduce symptom burden and hospitalizations, increase dose intensity and improve quality of life of patients during systemic therapy being recommended by international guidelines in routine oncology practice.”
From Implementation of a remote symptom monitoring pathway in oncology care: analysis of real-world experience across 33 cancer centres in France and Belgium (2024) · cites this paper as [11]
The Discussion (page unavailable) reports that prior work found patients exposed to ESAS were less likely to be hospitalized. However, the Methods describe symptom reporting at clinic kiosks, not remote monitoring, and the hospitalization statement is not limited to patients receiving systemic therapy. This paper therefore supports the hospitalization component, but not the claim’s setting and treatment qualifiers. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 21 · Cited by 111
Research works printed but not linked: 1
- [19]Therneau TM, Crowson S, Atkinson E. Using time dependent covariates and time dependent coefficients in the cox model. Mayo Clinic Report. 2018; 1: 1‐ 27.
- Authors
- Barbera, L., Sutradhar, R., Seow, H., Mittmann, N., Howell, D., Earle, C. C., Li, Q., & Thiruchelvam, D.
- Affiliations
- University of Calgary (CA)
- University of Toronto (CA)
- Institute for Clinical Evaluative Sciences (CA)
- Sunnybrook Hospital (CA)
- University Health Network (CA)
- Corresponding author
- Barbera, Lisa
- ORCID
- Venue
- Cancer Medicine
- Publisher
- Wiley
- Published
- 2020-08-14
- Volume
- 9
- Issue
- 19
- Pages
- 7107-7115
- ISSN
- 2045-7634 (ISSN-L)
- PMC
- PMC7541161
- OpenAlex
- W3049134616
- Cited by
- 111
- References
- 21
- Citations by year
- 2026: 7 · 2025: 29 · 2024: 18 · 2023: 21 · 2022: 23 · 2021: 11 · 2020: 2
- FWCI
- 5.15
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Cancer Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Canadian Cancer Society Research Institute (704686)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- Edmonton Symptom Assessment System, cancer symptoms, symptom assessment, overall survival, mortality, ambulatory cancer patients, quality of cancer care
- MeSH terms
- Patient Reported Outcome Measures, Aged, Female, Humans, Male, Middle Aged, Neoplasms, Ontario, Predictive Value of Tests, Registries, Retrospective Studies, Risk Factors, Time Factors, Databases, Factual, Risk Assessment, Symptom Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
