Edmonton Symptom Assessment System — Revised (ESAS-r)
10-item patient-rated symptom assessment tool used in palliative care. Rates pain, tiredness, drowsiness, nausea, appetite, shortness of breath, depression, anxiety, wellbeing, and an optional patient-specific symptom — each 0–10. Used to monitor symptom burden and treatment response.
Score interpretation
ESAS-r 0–20 — low overall symptom burden
→ Continue current management; reassess at each clinic visit or weekly in inpatient setting; document patient-specific trends; reinforce psychosocial support; ensure patient is aware of symptom progression reporting
ESAS-r 21–50 — moderate symptom burden; review management for high-scoring items
→ Review individual symptom scores ≥4; adjust symptom-specific management (analgesia, antiemetics, anxiolytics); oncology/palliative care team review; psychosocial support referral if emotional distress prominent; reassess within 24–48 hours after changes; consider occupational therapy, physiotherapy
ESAS-r ≥51 — high symptom burden; urgent palliative care input
→ Urgent palliative care specialist review; address symptoms scoring ≥7 as priority; consider opioid dose optimisation for pain/dyspnoea; parenteral route if oral not tolerated; psychological distress — psychiatric/psychology support; MDT meeting; consider inpatient palliative care or hospice admission; advance care planning review; family/carer support
Interpretation bands for the ESAS-r. Apply clinical judgement and local guidance.
References
- Bruera E et al. The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care. 1991;7(2):6–9.
- Watanabe SM et al. The Edmonton Symptom Assessment System, version 2 (ESAS-r): Development and first steps for its validation. J Pain Symptom Manage. 2011;42(3):453–461.
Related
Curated clinical cross-links plus same-class fallbacks.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.