The M. D. Anderson Symptom Inventory (MDASI)

The M. D. Anderson Symptom Inventory (MDASI; Cleeland et al., 2000) is a multisymptom patient-reported outcome (PRO) measure for clinical and research use. The MDASI’s 13 core symptom items include those found to have the highest frequency and/or severity in patients with various cancers and treatment types. The MDASI has several advantages over other symptom-assessment scales in that it applies broadly across cancer types and treatments, is easy for patients to complete, includes items related to symptom interference with daily life, and it is easily translated into other languages.

In response to the FDA draft guidance for the pharmaceutical industry on the use of PRO measures in medical product development to support labeling claims, we have prepared a MDASI User's Guide (PDF) to provide documentation of the  development and psychometric properties of the MDASI and its modules. The information offered therein addresses the recommendations in the FDA draft guidance and establishes the MDASI's adequacy as a measure to support medical product claims.

MDASI Features

• Purpose: To assess the severity of multiple symptoms and the impact of symptoms on daily functioning
• Population: Patients with symptoms due to cancer and cancer treatment
• Assessment Areas: Severity of multiple symptoms and the impact of symptoms on daily functioning during the last 24 hours
• Method: Self-report, interview or via telephone-based interactive voice response (IVR) system
• Time required: Five minutes
• Scoring: Please see the MDASI User's Guide
• Reliability: Cronbach alpha reliability ranges from 0.82 to 0.94

MDASI Modules

MDASI modules augment the 19 core MDASI symptom and interference items with additional items identified as unique to a particular patient population. MDASI modules may be disease-specific, disease-site-specific or treatment-specific. Available MDASI modules include:

• Brain tumor - MDASI-BT (Armstrong et al., 2006)
• Chronic graft-versus-host disease - MDASI-cGVHD (Williams et al., 2010)
• Chronic myeloid leukemia - MDASI-CML (Williams et al., 2011)
• Gastrointestinal cancer - MDASI-GI (Wang et al., 2010)
• Heart failure - MDASI-HF (Fadol et al., 2008)
• Head and neck cancer - MDASI-HN (Rosenthal et al., 2007)
• Lung cancer - MDASI-LC (Mendoza et al., 2011)
• Cancer of the spine - MDASI-SP (Armstrong et al., 2010)
• Thyroid cancer - MDASI-Thy (Gning et al., 2008)

MDASI Language Versions

The MDASI is available in the following languages. The MDASI may not be modified or translated into another language without the express written consent of the copyright holder, Dr. Charles S. Cleeland (see Notice of Copyright below).  

Click on the links in the table below to view a sample in PDF format.

P = both psychometrically and linguistically validated
L = linguistically validated only

BT = brain tumor
CL=chronic myeloid leukemia
GH=chronic graft-versus-host disease
GI = gastrointestinal
HF = heart failure
HN = head & neck cancer
LC = lung cancer
SP = cancer of the spine
TH = thyroid cancer

P = both psychometrically and linguistically validated
L = linguistically validated only

Future Validation Studies: We would like to collaborate with other investigators to develop and validate new language versions of the MDASI. Contact us at symptomresearch@mdanderson.org for more information.

To Order the MDASI

To use the MDASI in a publication or clinical or research trial, you must obtain permission and you must agree to comply with the copyright. Fees may apply (see below).

• To obtain permission, fill out our order form. The MDASI will be e-mailed to you as a PDF file within seven to 10 business days. If your request is urgent, please contact us via e-mail at symptomresearch@mdanderson.org or at the address/phone number below to make special arrangements.

The Department of Symptom Research
Attn: Assessment Tools
The University of Texas MD Anderson Cancer Center
1515 Holcombe Boulevard, Unit 1450
Houston, Texas 77030
713-745-3805

• The fee structure is as follows:
  • Non-funded academic research and individual clinical practice
    • Free of charge
  • Funded academic research
    • $300 per project for the first language version
    • $150 per each additional language version within a project
  • Commercial research
    • $1,000 per project for the first language version
    • $500 per each additional language version within a project

If applicable, an invoice will be e-mailed to you within 10 days. Please reference the invoice number on your payment. Include on the memo line, "MD Anderson Assessment Tool Distribution."

Notice of Copyright

The M. D. Anderson Symptom Inventory (MDASI) copyright is held by The University of Texas MD Anderson Cancer Center and administered by the MDASI's developer, Charles S. Cleeland, PhD. The copyright applies to the MDASI, its modules and all its derivatives in any language. 

The MDASI and its modules may not be used or reproduced without permission from the copyright administrator or his designee. Fees for use may apply (see above).

Neither the MDASI nor any of its modules may not be modified or translated into another language without the express written consent of the copyright administrator or his designee. Failure to comply may result in legal action. Contact us via e-mail at symptomresearch@mdanderson.org or at the address shown above to obtain permission to alter or translate the instrument.

Selected References

Armstrong TS, Cohen M, Eriksen L, Cleeland C. Content validity of self-report measurement instruments: an illustration from the development of the brain tumor module of the M. D. Anderson Symptom Inventory. Oncol Nurs Forum 32(3): 669-676, 2005.

Armstrong TS, Gning I, Mendoza TR, Vera-Bolanos E, Gilbert MR, Rhines LD, Weinberg JS, Sanchez-Williams G, Levin V, Burton AW, Cleeland C. Reliability and validity of the M. D. Anderson Symptom Inventory-Spine Tumor Module. J Neurosurg Spine 12(4): 421-430, 2010.

Armstrong TS, Mendoza T, Gning I, Coco C, Cohen MZ, Eriksen L, Gilbert MR, Cleeland C. Validation of the M. D. Anderson Symptom Inventory Brain Tumor Module (MDASI-BT). J Neurooncol 80(1): 27-35, 2006.

Cleeland CS, Mendoza TR, Wang XS, Chou C, Harle M, Morrissey M, & Engstrom MC. Assessing Symptom Distress in Cancer: The M. D. Anderson Symptom Inventory. Cancer 2000; 89:1634-1646.

Fadol A, Mendoza T, Gning I, Kernicki J, Symes L, Cleeland CS, Lenihan D. Psychometric testing of the MDASI-HF: a symptom assessment instrument for patients with cancer and concurrent heart failure. J Card Fail 14(6): 497-507, 2008.

Gning I, Trask PC, Mendoza TR, Harle MT, Gutierrez KA, Kitaka SA, Sherman SI, Cleeland CS. Development and initial validation of the thyroid cancer module of the M. D. Anderson Symptom Inventory. Oncology 76(1): 59-68, 2009.

Guirimand F, Buyck JF, Lauwers-Allot E, Revnik J, Kerguen T, Aegerter P, Brasseur L, Cleeland CS. Cancer-related symptom assessment in France: validation of the French M. D. Anderson Symptom Inventory. J Pain Symptom Manage 39(4): 721-733, 2010.

Ivanova MO, Ionova TI, Kalyadina SA, Uspenskaya OS, Kishtovich AV, Guo H, Mendoza TR, Novik A, Cleeland CS, Wang XS. Cancer-related symptom assessment in Russia: Validation and utility of the Russian M. D. Anderson Symptom Inventory. J Pain Symptom Manage 30(5): 443-453, 2005.

Lin CC, Chang AP, Cleeland CS, Mendoza TR, Wang XS. Taiwanese version of the M. D. Anderson Symptom Inventory: symptom assessment in cancer patients. J Pain Symptom Manage 33(2): 180-188, 2007.

Mendoza TR, Wang XS, Lu C, Palos GR, Liao Z, Mobley GM, Kapoor S, Cleeland CS. Measuring the symptom burden of lung cancer: the validity and utility of the lung cancer module of the M. D. Anderson Symptom Inventory (MDASI-LC). Oncologist, in press.

Mystakidou K, Cleeland C, Tsilika E, Primikiri A, Parpa E, Vlahos L, Mendoza T. Greek M. D. Anderson Symptom Inventory: validation and utility in a cancer patient population. Oncology 67: 203-210, 2004.

Okuyama T, Wang XS, Akechi T, Mendoza TR, Hosaka T, Cleeland CS, Uchitomi Y. Japanese version of the M. D. Anderson Symptom Inventory: a validation study. J Pain Symptom Manage 26(6): 1093-1104, 2003.

Rosenthal DI, Mendoza TR, Chambers MS, Asper JA, Gning I, Kies MS, Weber RS, Lewin JS, Garden AS, Ang KK, Wang S, Cleeland CS. Measuring head and neck cancer symptom burden: The development and validation of the M. D. Anderson Symptom Inventory, head and neck module. Head Neck 29(10): 923-931, 2007.

Wang XS, Laudico AV, Guo H, Mendoza TR, Matsuda ML, Yosuico VD, Fragante EP, Cleeland CS. Filipino version of the M. D. Anderson Symptom Inventory (MDASI-F): Validation and multisymptom measurement in cancer patients. J Pain Symptom Manage 31(6): 542-552, 2006.

Wang XS, Wang Y, Guo H, Mendoza TR, Hao XS, Cleeland CS. Chinese version of the M. D. Anderson Symptom Inventory (MDASI-C): Validation and application of symptom measurement in cancer patients. Cancer 101(8):1890-1901, 2004.

Wang XS, Williams LA, Eng C, Mendoza TR, Shah NA, Kirkendoll KJ, Shah PK, Trask PC, Palos GR, Cleeland CS. Validation and application of a module of the M. D. Anderson Symptom Inventory for measuring multiple symptoms in patients with gastrointestinal cancer (the MDASI-GI). Cancer 116(8): 2053-2063, 2010.

Williams LA, Couriel DR, Mendoza TR, McCarthy PL, Neumann JL, White MH, Mobley GM, Kapoor S, Hernandez L, Alousi AM, Cleeland CS. A new measure of symptom burden in chronic graft-versus-host disease [abstract]. CIBMTR/ASBMT 2010 BMT Tandem Meetings, Orlando FL, Feb 24-28, 2010. Biol Blood Marrow Transplant 16(2 Suppl 2): S177, 2/2010; 60.

Williams LA, Garcia-Gonzalez A, Ault P, Mendoza TR, Cleeland CS, Mobley GM, Williams JL, Cortes JE. A new symptom measure in chronic myeloid leukemia [abstract]. European Hematology Association 16th Congress, London UK, Jun 9-12, 2011. Haematologica 96(Suppl 1):S313-S314, 6/2011; 0683.

Yun YH, Mendoza TR, Kang IO, You CH, Roh JW, Lee CG, Lee WS, Lee KS, Bang S-M, Cleeland CS, Wang XS. Validation study of the Korean version of the M. D. Anderson Symptom Inventory. J Pain Symptom Manage 31(4): 345-352, 2006.