Edmonton Symptom Assessment System (ESAS)

Edmonton Symptom Assessment System:
(revised version) (ESAS-R)
Please circle the number that best describes how you feel NOW:

No Pain 0  1  2  3  4  5  6  7  8  9  10 Worst Possible Pain

No Tiredness (Tiredness = lack of energy) 0  1  2  3  4  5  6  7  8  9  10 Worst Possible Tiredness

No Drowsiness (Drowsiness = feeling sleepy) 0  1  2  3  4  5  6  7  8  9  10 Worst Possible Drowsiness

No Nausea  0  1  2  3  4  5  6  7  8  9  10 Worst Possible Nausea

No Lack of Appetite
Worst Possible
Lack of Appetite

No Shortness of Breath 0  1  2  3  4  5  6  7  8  9  10 Worst Possible Shortness of Breath

No Depression
(Depression = feeling sad)
0  1  2  3  4  5  6  7  8  9  10 Worst Possible Depression

No Anxiety(Anxiety = feeling nervous)
    0  1  2  3  4  5  6  7  8  9  10 Worst Possible Anxiety

Best Wellbeing
(Wellbeing = how you feel overall)
   0  1  2  3  4  5  6  7  8  9  10 Worst Possible Wellbeing
No __________

Other Problem (for example constipation)
0  1  2  3  4  5  6  7  8 9 10
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