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Attitudes of oncologists towards palliative care and the Edmonton Symptom Assessment System (ESAS) at an Ontario cancer center in Canada



Cancer Care Ontario promotes the Edmonton Symptom Assessment System (ESAS) for standardized systematic screening and assessment of symptoms across cancer centers in Ontario, Canada. Attitudes of medical oncologists (MOs), radiation oncologists (ROs), and general practitioners in oncology (GPOs) toward palliative care, and the ESAS were surveyed in Ottawa.


A four-part questionnaire was developed, drawing on items from similar studies.


Forty respondents (17 MOs, 16 ROs, and 7 GPOs) were interviewed. Attitudes to palliative care: regarding coordination of care across the illness trajectory including end of life by MOs, all ROs disagreed while 71.4 % of GPOs and 41.2 % of MOs agreed that this was the MO’s role. Most respondents supported palliative care alongside concurrent anti-tumor therapies (82.4 % MOs, 62.5 % ROs, and 100 % GPOs). Attitudes to ESAS: respondents agreed that the ESAS enhances care and assessment of symptom severity. ROs felt that reviewing the ESAS histogram was less useful than did MOs (42.9 versus 76.5 %, respectively); 56.3 % of ROs and 88.2 % of MOs agreed that the ESAS is useful for follow-up (p < 0.08); 64.7 % of MOs, 88.3 % of GPOs, and 6.3 % of ROs agreed with ESAS completion at every visit (p < 0.00). Frequency of use of the ESAS: 62.5 % of respondents reported inspecting the ESAS “most of the time or always,” while 17.5 % reported “never” or “rarely.”


MOs and GPOs appear more positive than ROs toward regular use of ESAS. There is discordance between what is perceived to be a useful beneficial instrument versus actual use of the instrument in daily practice. The reasons for this gap need to be better understood in future studies.

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The authors wish to thank Iftikhar Ahmed for his dedication to this project and interviewing of the participants.

Conflict of interest

The authors have declared no conflicts of interest.

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Corresponding author

Correspondence to Martin Chasen.


Appendix 1

Table 1 Attitudes related to palliative care and palliative care services (Adapted from Cherny et al. [12]; N = 40 (total and by specific group in %)

Appendix 2

Table 2 Attitudes related to the Edmonton Symptom Assessment System (Adapted from Bainbridge et al. [10]; N = 40 (total and by specific group in %)

Appendix 3

Table 3 Frequency of use of the Edmonton Symptom Assessment System (ESAS; N = 40)

Appendix 4

Table 4 Attitudes related to the Cancer Care Ontario (CCO) guidelines and algorithm (N = 40)

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Chasen, M., Bhargava, R., Dalzell, C. et al. Attitudes of oncologists towards palliative care and the Edmonton Symptom Assessment System (ESAS) at an Ontario cancer center in Canada. Support Care Cancer 23, 769–778 (2015).

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  • ESAS
  • Symptom assessment
  • Cancer