Multidimensional symptom burden in palliative care. Free to use.
ESAS-r (Edmonton Symptom Assessment System (revised)) is a validated clinical instrument used to assess multidimensional symptom burden in palliative care. The instrument contains 9 items.
Source / attribution: Watanabe SM et al. J Pain Symptom Manage. 2011;41(2):456-468.
The instrument's primary construct — multidimensional symptom burden in palliative care — is operationalized through a fixed set of items, each with a defined response format. This standardisation is what allows ESAS-r scores to be compared meaningfully across clinicians, sites, and studies.
Like all screening or assessment instruments, ESAS-r is a structured aid — not a diagnostic test in isolation. Results should be interpreted alongside history, examination, and clinical context. Where a score crosses an actionable threshold, the next step is typically a more detailed clinical evaluation rather than a definitive diagnosis.
Answer all 9 items below to see your ESAS-r score and interpretation.
All scoring runs in your browser. No data is sent anywhere — close the tab and the answers are gone.
ESAS-r uses simple summation: each item's selected response is converted to a numeric value, and the values are added to produce a total score. Reverse-scored items are inverted before summation.
Scoring notes: Per-symptom severity is also clinically informative: 0–3 mild, 4–6 moderate, 7–10 severe.
The cutoffs below are drawn from the published validation literature. Always interpret in clinical context.
| Score range | Band | Interpretation |
|---|---|---|
| 0–9 | Mild symptom burden | Most symptoms in mild range; routine review. |
| 10–29 | Moderate symptom burden | Several symptoms moderate; structured palliative review. |
| 30–90 | Severe symptom burden | High burden; specialist palliative care referral. |
This is an illustrative walkthrough, not a real patient. Follow the same four steps with your own answers — or use the live calculator at the top of this page.
Read each question and choose the response that best fits. Each response has a number next to it — that number is the item's score. The example below uses illustrative answers.
| # | Item | Example response | Score |
|---|---|---|---|
| 1 | Pain (0 = no pain → 10 = worst possible) | 1 | 1 |
| 2 | Tiredness (0 = none → 10 = worst possible) | 1 | 1 |
| 3 | Drowsiness (0 = none → 10 = worst possible) | 0 | 0 |
| 4 | Nausea (0 = none → 10 = worst possible) | 1 | 1 |
| 5 | Lack of appetite (0 = best appetite → 10 = no appetite) | 0 | 0 |
| 6 | Shortness of breath (0 = none → 10 = worst possible) | 1 | 1 |
| 7 | Depression (0 = none → 10 = worst possible) | 0 | 0 |
| 8 | Anxiety (0 = none → 10 = worst possible) | 1 | 1 |
| 9 | Wellbeing (0 = best → 10 = worst possible) | 0 | 0 |
Add up all the item scores you noted in Step 1.
1 + 1 + 0 + 1 + 0 + 1 + 0 + 1 + 0 = 5
Find the row in the interpretation table whose range contains your total:
Total = 5 falls between 0 and 9 → Mild symptom burden
Mild symptom burden. Most symptoms in mild range; routine review.
A score is one input alongside history and examination. ESAS-r supports clinical judgment — it does not replace it.
If ESAS-r doesn't fit your context, related instruments in palliative include:
| Scale | Measures | Items | Time |
|---|---|---|---|
| ODI | Self-reported low-back-pain functional disability | 10 | — |
| NDI | Self-reported neck-pain functional disability | 10 | — |
| Oxford Knee Score | Pain and function after total knee replacement | 12 | — |
| Oxford Hip Score | Pain and function after total hip replacement | 12 | — |
| LEFS | Function with lower-extremity musculoskeletal disorders | 20 | — |
| IPSS | Lower-urinary-tract symptoms in men | 7 | — |
| IIEF-5 / SHIM | Erectile dysfunction screen | 5 | — |
| DLQI | Skin-disease impact on health-related quality of life | 10 | ≈ 2 minutes |
ESAS-r (Edmonton Symptom Assessment System (revised)) is a validated instrument that assesses multidimensional symptom burden in palliative care. It is designed for clinicians, medical students, evidence-synthesis researchers. The 9 items are summed to produce a total score.
ESAS-r contains 9 items. Item scores are summed to produce the total. Scores run from 0 to 90, grouped into 3 interpretation bands from ‘Mild symptom burden’ up to ‘Severe symptom burden’.
On the ESAS-r (total score 0–90), scores of 30–90 fall in the ‘Severe symptom burden’ band — interpreted as: High burden; specialist palliative care referral. The full ladder is: 0–9 — Mild symptom burden: Most symptoms in mild range; routine review.; 10–29 — Moderate symptom burden: Several symptoms moderate; structured palliative review.; 30–90 — Severe symptom burden: High burden; specialist palliative care referral. A higher score reflects a more severe presentation, and crossing a cutoff is a prompt to step up assessment or care — but these bands are screening thresholds, not diagnoses.
Scores of 0–9 fall in the ‘Mild symptom burden’ band: Most symptoms in mild range; routine review. A low score is reassuring but does not by itself rule out the underlying condition — if symptoms or clinical suspicion persist, reassess over time or use a complementary evaluation rather than relying on the number alone.
Yes — ESAS-r is in the public domain and free for clinical, educational, and research use without permission. You can use this calculator and the scale itself freely; if you publish results or reproduce the scale, cite the original source paper.
Watanabe SM et al. A multicenter study comparing two numerical versions of the Edmonton Symptom Assessment System (ESAS) in palliative care patients. J Pain Symptom Manage. 2011;41(2):456-468. This is the original publication for the ESAS-r — the reference to cite when reporting results.
No. ESAS-r is a structured assessment aid, not a diagnostic test. Its proper role is clinical assessment of multidimensional symptom burden in palliative care — it standardizes assessment and flags who needs closer evaluation, but the result must be weighed alongside history, examination, and clinical context. When a score conflicts with your clinical impression, clinical judgment takes precedence; treatment decisions should never rest on a screening score alone.
ESAS-r is supported by the following peer-reviewed sources: