Validation of the Edmonton symptom assessment system in Korean patients with cancer

Jung Hye Kwon, Seung Hyun Nam, Sujin Koh, Young Seon Hong, Kyung Hee Lee, Sang Won Shin, David Hui, Kyun Woo Park, So Young Yoon, Ji Yun Won, Gary Chisholm, Eduardo Bruera

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)


Context: The Edmonton Symptom Assessment System (ESAS) is a brief, widely adopted, multidimensional questionnaire to evaluate patient-reported symptoms. Objectives: To develop a Korean version of the ESAS (K-ESAS) and to perform a psychometric analysis in Korean patients with advanced cancer. Methods: We tested the K-ESAS in two pilot studies with 15 patients each. We assessed internal consistency, test-retest reliability, and concurrent validity in 163 Korean patients, who completed the K-ESAS along with the Korean versions of the M. D. Anderson Symptom Inventory (K-MDASI) and the Hospital Anxiety and Depression Scale (K-HADS) twice. A total of 38 patients completed the questionnaires again seven days later to assess responsiveness. Results: The K-ESAS scores had good internal consistency, with a Cronbach's alpha coefficient of 0.88, indicating that no questions had undue influence on the score. Pearson correlation coefficients for K-ESAS symptom scores between baseline and after two to four hours ranged from 0.72 (95% CI 0.64-0.79) to 0.87 (95% CI 0.82-0.90), indicating strong test-retest reliability. For concurrent validity, Pearson correlation coefficients between K-ESAS symptom scores and corresponding K-MDASI symptom scores ranged from 0.70 (95% CI 0.62-0.77) to 0.83 (95% CI 0.77-0.87), indicating good concurrent validity. For the K-HADS, concurrent validity was good for anxiety (r = 0.73, 95% CI 0.65-0.79) but moderate for depression (r = 0.4, 95% CI 0.26-0.52). For responsiveness, changes in K-ESAS scores after seven days were moderately correlated with changes in K-MDASI scores but weakly correlated with changes in K-HADS scores. Conclusion: The K-ESAS is a valid and reliable tool for measuring multidimensional symptoms in Korean patients with cancer.

Original languageEnglish
Pages (from-to)947-956
Number of pages10
JournalJournal of Pain and Symptom Management
Issue number6
Publication statusPublished - 2013 Dec
Externally publishedYes


  • Advanced cancer
  • ESAS
  • Edmonton Symptom Assessment System
  • Korea

ASJC Scopus subject areas

  • General Nursing
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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