ORIGINAL ARTICLE The Edmonton Symptom Assessment System (ESAS) as a screening tool for depression and anxiety in non-advanced patients with solid or haematological malignancies on cure or follow-up Carla I. Ripamonti & Elena Bandieri & Maria Adelaide Pessi & Alice Maruelli & Loredana Buonaccorso & Guido Miccinesi Received: 27 May 2013 /Accepted: 28 October 2013 /Published online: 26 November 2013 # Springer-Verlag Berlin Heidelberg 2013 Abstract Background Symptoms’ assessment should be considered a clinical practice routine in all cancer stages. The Edmonton Symptom Assessment System (ESAS) is a ten-item patient- rated symptom assessment developed and validated for pop- ulation affected by cancer in different languages and cultures. The main objective of this study was to assess the perfor- mance of ESAS items on anxiety and depression when de- tecting Hospital Anxiety Depression Scale (HADS) ‘cases’. Methods A cross-sectional study was carried out on 194 non- advanced patients with solid (108) or hematologic malignan- cies on cure or follow up, Karnofsky Performance Status ≥ 70, life expectancy>6 months and no metastases. Patients were assessed by means of ESAS and by HADS. Receiving operator characteristic (ROC) analysis of ESAS anxiety and depression items versus cases of severe (cutoff 11) anxiety and depression according to HADS-specific subscales was performed. Results Depression and anxiety ESAS items correlated strongly (0.707, Spearman). Area under the curve ranged between 0.84 and 0.96 for the two ESAS items when detecting severe anxiety or depression HADS cases (cutoff=11). ESAS anxiety or depression scores >3 detected quite well the severe depression HADS cases (Sensibility=75–Specificity=84, Sensibility=87–Specificity=90, respectively). Conclusions Anxiety or depression ESAS items score >3 can be applied as a useful, easy and not time consuming screening tool for assessing anxiety and depression in non-advanced patients with solid or haematological malignancies. Keywords Anxiety . Depression screening tools . ESAS . HADS Introduction Assessment of the presence and severity of physical and emo- tional symptoms should be part of the daily clinical activity of healthcare providers in all stages of the oncological disease in order to ensure early identification of suffering due to cancer and its treatments, so that those concerns can be addressed at the earliest opportunity and when necessary referred to specialists. While this practice is one of the palliative care goals, in oncological settings symptoms’ assessment is frequently con- sidered only for patients involved in clinical trials [1], even if recommendations claim that all cancer patients should be screened for pain [2] and other physical symptoms as well as for their level of distress starting from the first initial visit with their oncologist, by using screening tools [3–5]. More attention should be given to depression and other distressing symptoms by healthcare providers involved in the treatment of oncological patients even if they are not trained in mental health. C. I. Ripamonti (*) : M. A. Pessi Department of Hematology and Pediatric Onco-Hematology, Supportive Care in Cancer Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Venezian, 1, 20133 Milan, Italy e-mail: carla.ripamonti@istitutotumori.mi.it E. Bandieri Oncological Unit, Azienda Usl Modena (CeVEAS), Modena, Italy A. Maruelli Psychology Unit, LILT and Center for Oncological Rehabilitation-CERION of Florence, Florence, Italy L. Buonaccorso AMO, Association of Oncological Patients from nine towns and villages located in the Northern area of Modena, Modena, Italy G. Miccinesi Clinical Epidemiology Unit, ISPO-Institute for the Study and Prevention of Cancer, Florence, Italy Support Care Cancer (2014) 22:783–793 DOI 10.1007/s00520-013-2034-x