A comparison of the prevalence of dry mouth and other symptoms using two different versions of the Edmonton Symptom Assessment System on an inpatient palliative care unit

BMC Palliat Care. 2024 Mar 16;23(1):75. doi: 10.1186/s12904-024-01405-7.


Background: Symptom assessment is key to effective symptom management and palliative care for patients with advanced cancer. Symptom prevalence and severity estimates vary widely, possibly dependent on the assessment tool used. Are symptoms specifically asked about or must the patients add them as additional symptoms? This study compared the prevalence and severity of patient-reported symptoms in two different versions of a multi-symptom assessment tool. In one version, three symptoms dry mouth, constipation, sleep problems were among those systematically assessed, while in the other, these symptoms had to be added as an "Other problem".

Methods: This retrospective cross-sectional study included adult patients with advanced cancer at an inpatient palliative care unit. Data were collected from two versions of the Edmonton Symptom Assessment System (ESAS): modified (ESAS-m) listed 11 symptoms and revised (ESAS-r) listed 9 and allowed patients to add one "Other problem". Seven similar symptoms were listed in both versions.

Results: In 2013, 184 patients completed ESAS-m, and in 2017, 156 completed ESAS-r. Prevalence and severity of symptoms listed in both versions did not differ. In ESAS-m, 83% reported dry mouth, 73% constipation, and 71% sleep problems, but on ESAS-r, these symptoms were reported by only 3%, 15% and < 1%, respectively. Although ESAS-r severity scores for these three symptoms were higher than on ESAS-m, differences did not reach statistical significance.

Conclusion: We identified significant differences in patient symptom reporting based on whether symptoms like dry mouth, obstipation and sleep problems were specifically assessed or had to be added by patients as an "Other problem".

Keywords: Advanced cancer; Dry mouth; Edmonton Symptom Assessment System; Open-ended question; Symptom assessment.

MeSH terms

  • Adult
  • Constipation / diagnosis
  • Constipation / epidemiology
  • Cross-Sectional Studies
  • Humans
  • Inpatients
  • Neoplasms* / complications
  • Neoplasms* / epidemiology
  • Neoplasms* / therapy
  • Palliative Care
  • Prevalence
  • Retrospective Studies
  • Sleep Wake Disorders*
  • Symptom Assessment