The BC Cancer Agency sees 128,172 patients per year, of which 2,186 are referred to the Patient Symptom Management/Palliative Care (PSMPC) clinics for tertiary symptom management. Other than at the PSMPC clinics, screening for symptom distress is extremely variable because there is no systematic assessment protocol. In a recent audit of patients coming to the Cancer Agency, approximately 64% of patients reported experiencing a moderate to severe level of symptom distress. Of the total patients in the audit (n = 1,147), only 18 were seen by the PSMPC teams and it is unclear whether or not the remaining patients had their symptoms attended to by a health professional at the BCCA.

The tool which the BCCA has chosen for screening and assessment is the Edmonton Symptom Assessment System (ESAS), which was developed by Dr. Eduardo Bruera. ESAS is a nine-item, self-reporting, visual analogue instrument used to measure pain and other symptoms using numeric ratings. Cancer Care Ontario (CCO) has developed an electronic means whereby patients' ESAS scores are entered and housed in an electronic health record and then used for triage. BCCA is in partnership with CCO to adapt this system for use in BC.