Symptom Assessment Tools

Brief Pain Inventory  |   MD Anderson Symptom Inventory   |   Brief Fatigue Inventory



A symptom is a sensation or perception of change related to health function experienced by an individual. Symptoms, such as fatigue, pain and nausea, may be classified based on their severity and perceived impact on function. Symptoms add to the burden of having a chronic disease, such as cancer, and affect virtually all aspects of life. They interfere with a person's mood, level of activity and ability to relate to others.

The study of symptoms has consisted primarily of descriptive studies of self-report from patients at specific stages of specific types of cancer. Such patient-reported outcomes (PROs) have been recognized by the US Food and Drug Administration as legitimate primary outcome variables for clinical trials.

The Department of Symptom Research has been working since 1979 to design PRO assessment tools for symptoms experienced by cancer patients to determine their severity, and how they affect quality of life. 

The Brief Pain Inventory (BPI)

The Brief Pain Inventory (BPI) was developed in 1989 by Dr. Charles Cleeland for rapid assessment of the severity and impact of pain in cancer patients. The BPI has since been translated into more than three dozen languages, and is widely used in both research and clinical settings.

A BPI User's Guide addressing FDA requirements for use of patient-reported outcomes in clinical trials is now available. 

The M. D. Anderson Symptom Inventory (MDASI)

The MD Anderson Symptom Inventory (MDASI) is used to assess multiple symptoms experienced by cancer patients and the interference with daily living caused by these symptoms. The MDASI is available in both paper-and-pencil and interactive voice response (IVR) formats, both of which are equally effective.

A MDASI User's Guide addressing FDA requirements for use of patient-reported outcomes in clinical trials is now available. 

The MDASI-IVR combines the use of touch-tone telephones with computers and the Internet to follow symptoms while the patient is away from the hospital. The MDASI-IVR offers several benefits: (1) missing data are minimized, especially in longitudinal studies; (2) the IVR provides more accurate real-time symptom assessment data at expected time points; and (3) the availability of immediate feedback through the IVR system could allow caregivers to address severe symptoms more effectively.

The Brief Fatigue Inventory (BFI)

The Brief Fatigue Inventory (BFI) is used to rapidly assess the severity and impact of cancer-related fatigue. An increasing focus on cancer-related fatigue emphasized the need for sensitive tools to assess this most frequently reported symptom. The six inventory items correlate with standard quality-of-life measures.

Ease of Use and Readability

Our symptom assessment tools are understandable even by grade-school children, according to the Flesch scoring systems described below.

Flesch Reading Ease score: Rates text on a 100-point scale; the higher the score, the easier it is to understand the document. Most standard documents aim for a score of approximately 60 to 70.

Flesch-Kincaid Grade Level score: Rates text on a U.S. grade-school level. For example, a score of 8.0 means that an eighth grader can understand the document. Most standard documents aim for a score of approximately 7.0 to 8.0.


 Flesch Reading EaseFlesch-Kincaid Grade Level
BPI (short form)83.55.1


The simplicity of the tools facilitates cross-cultural studies of pain and other patient-reported cancer-related symptoms. Validation studies have not been conducted using our assessment tools in the pediatric population, aged 18 years and younger.

Related News

Symptom Research hosts national colloquium on developing strategies for reducing cancer treatment-related toxicities and symptoms. Read more...

 Cancer Symptom Science

Announcing the publication of Cancer Symptom Science, an interdisciplinary, first-of-its-kind compilation of research on the mechanisms underlying the expression of cancer-related symptoms. Read more...

Old Drugs, New Possibilities (Conquest, Fall 2008)

Symptom Research Awarded NIH P01 Grant (Division of Internal Medicine Newsletter, Summer 2008)

Symptom Research and Psychometrics (Network, Summer 2008)