# Using the Edmonton Symptom Assessment System (ESAS) to Describe Symptom Burden Associated with Breast Cancer and Related Treatments: A Cross-Sectional Study

## TL;DR

This study shows that many breast cancer patients, even those with early-stage disease, experience moderate to severe symptoms that require medical attention.

## Contribution

The study highlights the importance of using the Edmonton Symptom Assessment System (ESAS) to identify clinically significant symptoms in breast cancer patients across all stages.

## Key findings

- 70% of breast cancer patients reported at least one moderate to severe symptom.
- Tiredness, lack of well-being, and anxiety were the most common severe symptoms.
- Threshold-based use of ESAS better identifies patient needs than mean scores.

## Abstract

Breast cancer is the most common cancer among women. Many patients experience symptoms that affect their ability to function, including feeling tired, having low energy, experiencing anxiety, and an overall sense of not feeling well. While some women report only mild discomfort, many have symptoms that are moderate to severe and may require medical attention. In our study, we asked women who had a range of stages of breast cancer to report their symptoms and daily functioning. We found that about 7 out of 10 had at least one symptom that was strong enough to need extra care. Importantly, symptoms were common for both women with advanced breast cancer and for those with earlier-stage disease, who were expected to be cured. These findings show how important it is for doctors and nurses to ask patients directly about their symptoms during clinic visits. Regular symptom checks can help healthcare teams identify who needs more support, provide timely treatment, and improve quality of life for women living with breast cancer.

Background: Symptom burden and functional impairment are common in women with breast cancer, yet their prevalence and clinical significance across the disease spectrum remain underexplored. We sought to describe symptom burden and performance status using patient-reported outcome measures and to identify patient characteristics associated with symptoms requiring clinical intervention. Methods: In this cross-sectional study, women with stage I–IV breast cancer completed the Edmonton Symptom Assessment System (ESAS) and the Patient-Reported Functional Status tool. We assessed the prevalence and severity of symptoms and calculated summary distress scores. Multivariable logistic regression was used to identify patient characteristics associated with clinically significant symptoms (ESAS ≥ 4). Results: Among 381 women (mean age 56.8 years; 27% metastatic; 72% with no comorbidities), 70% reported at least one moderate to severe symptom. The most common were tiredness (31%), lack of well-being (30%), and anxiety (21%). Mean summary distress scores were low overall. Most patients reported functional status scores of 0 or 1, and 43% of those with scores ≥2 had metastatic disease. Compared with metastatic patients, women within the first year after diagnosis were less likely to report a symptom requiring intervention (OR 0.49, 95% CI 0.24–0.90). Conclusions: Clinically significant symptoms are common among women with breast cancer, including those with potentially curable disease. Threshold-based use of ESAS, rather than reliance on mean scores, provides a more accurate assessment of patient needs. These findings support the routine integration of patient-reported outcomes into oncology care and underscore the importance of targeted multidisciplinary interventions.