CHALLENGES IN THE EDMONTON SYMPTOM ASSESMENT SCALE (ESAS) IMPLEMENTATION IN THE ONCOLOGY AND HEMATOLOGY UNIT BY THE INTEGRATIVE MEDICINE GROUP OF A PRIVATE TERCIARY HOSPITAL IN SÃO PAULO: EXPERIENCE REPORT

Case presentation: The use of complementary and integrative medicine (CIM) by cancer patients is well-known in the oncology setting, mostly related to the desire to increase the chances of cure, minimize side effects and also participate actively of their salutogenesis. The Edmonton Symptom Assesment Scale (ESAS) has been used as self-reported symptoms tool in Integrative Medicine Centers in the United States. We describe our recent experience in implementing the ESAS in the oncology and hematology unit for inpatients pre and post integrative therapy (IT) performed by integrative medicine group (IMG). Discussion: The IMG acts in the oncology and hematology center since 2007 offering IT to all inpatients with no charge to patients and caregivers. The IT are individualized non-invasive mind-body thecniques, adapted to patients needs and limitations, including gentle movements and breathing exercises based on yoga, touch therapy and relaxation thecniques conducted by therapists voice, during 20-30minutes. From 12th June to 19th July 2019 the ESAS was implemented pre and post IT. The first step before including the scale in the routine was education of the IMG with discussion of ESAS by a physician and nurse experts in palliative care. None of the four mind-body therapists had ever worked at a hospital or with ESAS before joining IMG. Secondly a standardized speech was stablished with clear explanation to patients of the importance of the evaluation and their voluntary participation with no implications if they refuse to fill the scale. An extra note was added to the ESAS with observation gap to better understand the challenges during the sessions. Eighty ESAS were completed during the 40 sessions to 31 adult patients. Twenty were filled by patients and 17 by therapists. Ten patients slept during the session and 7 didnt filled the post ESAS immediatly after the end of the session. Two patients couldnt understand the instructions due to confuse state and 2 patients refused to fill the post ESAS. One patient didnt understand the intruction. Final Comments: In our experience implementing the ESAS in the routine of the IMG represents a challenge regarding the lack of experience of the group with symptom scales, patient approach and sleeping during the sessions. However, the evaluation was well-accepted by the group and patients to better understand the benefits of IT and also to facilitate the communication with the multidisciplinary and physician teams.