The MD Anderson Symptom Inventory
The MD Anderson Symptom Inventory (MDASI) is a multi-symptom patient-reported outcome (PRO) measure for clinical and research use. Use the MDASI to assess the severity of symptoms experienced by patients with cancer and the interference with daily living caused by these symptoms.
The core MDASI includes 13 symptom items and 6 interference items. The symptom items are those found to have the highest frequency and/or severity in patients with various cancers and treatment types.
| MDASI Core Symptom Items (common across cancer types and treatments) | MDASI Interference Items |
|---|---|
| Pain |
Walking |
| Fatigue | Activity |
| Nausea | Working (including housework) |
| Disturbed sleep |
Relations with other people |
| Distress/feeling upset |
Enjoyment of life |
| Shortness of breath |
Mood |
| Problem with remembering things |
|
| Lack of appetite |
|
| Drowsiness | |
| Dry mouth |
|
| Feeling sad | |
| Vomiting | |
| Numbness/tingling |
Disease site-specific and treatment-specific MDASI modules are available (sidebar, right).
The MDASI has several advantages over other symptom-assessment scales:
- It assesses both symptom severity and symptom interference with daily life
- It applies broadly across cancer types and treatments
- It can be adapted to specific cancer types, sites, and treatments (MDASI modules)
- Its 0-10 scale is easy for patients to understand and complete
- It is easily translated into other languages
MDASI Features
- Purpose: To assess the severity of multiple cancer-related symptoms and the impact of these symptoms on daily functioning
- Population: Patients with symptoms caused by 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 or interview with research staff; paper-and-pencil, telephone interface, or electronic data entry*
- Time required: Five minutes or less
- Scoring: Please see the MDASI User Guide
- Reliability: Cronbach alpha reliability ranges from 0.82 to 0.94
*Electronic data capture offers several benefits:
- Allows symptom monitoring when the patient is away from the hospital
- Is convenient for patients, who can choose web access, personalized patient portals, or smartphones to access questionnaires
- Minimizes missing data, especially in longitudinal studies
- Provides accurate, real-time symptom data at expected time points
- Generates immediate feedback, potentially allowing caregivers to address severe symptoms more effectively
Order the MDASI
Use our convenient online form to order the MDASI and the MDASI modules for use in your clinical research, clinical practice, funded and non-funded academic research, commercial research, or reproduction in educational materials or other publications.
View the MDASI
The MDASI Symptom Library
Individual and sets of symptom items from the MDASI Symptom Library may be added to the core MDASI or a MDASI module (sidebar, right) to create an experimental MDASI that is tailored to your clinical research or practice. We append these additional items to the end of the original questionnaire to maintain the integrity of its psychometric validity.
All symptom items are available in English, as well as in other languages.
Contact us to obtain permission to use any of the MDASI Symptom Library items to create a tailored questionnaire (REQUIRED). Our expert faculty can assist you with:
- Design of a customized MDASI that meets the needs of your study or practice;
- Available linguistically and psychometrically validated language translations of your selected items;
- Information about the sensitivity of particular items in specific populations.
Charges will apply for consultation services. Charge will depend on the scope of the request.
ITEMS MAY NOT BE USED WITHOUT CONSULTATION.
| SYMPTOM | SOURCE MDASI |
|---|---|
| Abdominal cramping | PeriOp-GYN |
| Abdomal swelling or fullness | GIST |
| Back pain | OC |
| Balance or falling | MPM, SCLC |
| Bloating/abdominal tightness | PeriOp-GYN |
| Blood in urine | PeriOp-BLC |
| Breast changes | Br |
| Bone aches | MM |
| Bruising easily or bleeding | CLL, CML, GIST |
| Change in appearance | BT |
| Change in sexual function | cGVHD |
| Change in sense of smell | COVID, GI |
| Change in taste | COVID, GI |
| Change in vision | BT |
| Chest heaviness or tightness | MPM |
| Choking/coughing (food/liquids going down wrong pipe) | HN |
| Constipation | Br, CLL, HN, GI. LC, MM, OC |
| Coughing | LC, TT |
| Diarrhea | AML, CLL, CML, cGVHD, GIST, CLL RCC |
| Diarrhea or watery stools via stoma (abdominal opening | GI |
| Difficulty speaking (finding the words) | BT |
| Difficulty chewing | HN |
| Difficulty concentrating | BT |
| Difficulty swallowing | GI, Thy, TT |
| Difficulty swallowing/chewing | HN |
| Difficulty understanding | BT |
| Difficulty with voice/speech | HN |
| Disturbed sleep | Core |
| Dizziness | PeriOp-GYN |
| Eye problems | cGVHD |
| Feeling drowsy/sleepy | Core |
| Fatigue/tiredness | Core |
| Feeling bloated | GI, OC, OC Plus |
| Feeling distressed/upset | Core |
| Feeling of malaise (not feeling well) | AML/MDS, CML |
| Feeling physically sick | BMT |
| Feeling physically weak | BMT |
| Fever or chills | AML/MDS, EPT |
| Frequent urination | PeriOp-BLC |
| Grogginess or confusion | PeriOp-GYN |
| Dry mouth | Core |
| Headache | AML/MDS, CML, RCC, COVID, EPT |
| Hoarseness | Thy |
| Hot flashes | Br, PeriOp-GYN |
| Inability to eat | ESO |
| Inability/difficulty urinating | PeriOp-GYN |
| Irritability | BT |
| Itching | Skin |
| Joint stiffness or soreness | cGVHD |
| Leaking urine | PeriOp-BLC |
| Leg cramps or leg muscle pain | OC, OC Plus |
| Loss of bowel and/or bladder control | SP |
| Mouth/throat sores | HN, RCC-23 |
| Muscle soreness or cramping | CML, GIST |
| Muscle weakness | AML/MDS, cGVHD, GVHD-GI, MM, MPM |
| Nausea | Core |
| Night sweats | CLL, EPT |
| Numbness or tingling | Core |
| Pain | Core |
| Pain in the abdomen | OC |
| Pain or burning with urination | OC, EPT |
| Problem with bitter taste | TCM |
| Problem with feeling cold | Thy, TCM |
| Problem with lack of appetite | Core |
| Problem with mucus in mouth and throat | HN |
| Problem with nighttime coughing | HF |
| Problem with paying attention/concentrating | MM, OC, TT, OC Plus |
| Problem with racing heartbeat/palpitation | HF, TCM |
| Problem remembering | Core |
| Problem with sweating | TCM |
| Problem with tasting food | HN |
| Problem with teeth or gums | HN |
| Radiating spine pain | SP |
| Rash | MM, Skin |
| Rash or skin change | CML, OC Plus, RCC-23, EPT |
| Regurgitation (acid reflux) | ESO |
| Sadness | Core |
| Shortness of breath | Core |
| Skin pain/burning/rash | HN |
| Skin problems | AML/MDS, cGVHD, GIST |
| Sore mouth or throat | MM, OC, OC Plus, ESO |
| Sore throat | LC, TT, LC Modified |
| Stomal problems | PeriOp-BLC |
| Swelling of feet | SCLC |
| Swelling of hands, legs, feet, abdomen, or around eyes | CML, GIST, EPT |
| Urinary urgency | OC, OC Plus |
| Vaginal discharge or bleeding | CX |
| Vaginal dryness | Br |
| Vision problems | BT |
| Vomiting | Core |
| Weakness on one side of body | BT |
MDASI Language Translations
Don't see a language you need? Contact us at symptomresearch@mdanderson.org.
| Psychometrically and Linguistically Validated | Linguistically Validated |
|---|---|
| Arabic | Afrikaans |
| Chinese (Simplified) | Amharic |
| Chinese (Traditional) | Belarusian |
| English | Bengali |
| Filipino | Bosnian/Herzegovinian |
| French | Croatian |
| Greek | Czech |
| Japanese | Danish |
| Korean | Dutch |
| Russian | Estonian |
| Finnish | |
| German | |
| Gujarati | |
| Hebrew | |
| Hindi | |
| Hungarian | |
| Icelandic | |
| Italian | |
| Kannada | |
| Khmer (in process) | |
| Latvian | |
| Malay | |
| Malayalam | |
| Marathi | |
| Norwegian | |
| Polish | |
| Portuguese (Brazil) |
|
| Portuguese (Portugal) |
|
| Romanian | |
| Serbian | |
| Slovak | |
| Spanish | |
| Swedish | |
| Tamil | |
| Telugu | |
| Thai | |
| Turkish | |
| Ukranian | |
| Vietnamese |
The MDASI User Guide
In response to the US Food and Drug Administration's 2009 guidance for the pharmaceutical industry on the use of patient-reported outcomes measures in medical product development to support labeling claims, we have prepared a MDASI User Guide to document the development and psychometric properties of the MDASI and its modules. The User Guide addresses the recommendations in the FDA guidance and establishes the MDASI's adequacy as a measure to support medical product claims.
Request a copy of the MDASI User Guide.
Selected MDASI References
Validation
Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer: The M. D. Anderson Symptom Inventory. Cancer 89:1634-1646, 2000.
Li J, Chen T, Gao J, et al. Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients undergoing prostatectomy: a multicentre, prospective, observational cohort study protocol. BMJ Open 13(8):e074763, 2023.
Guirimand F, Buyck JF, Lauwers-Allot E, et al. Cancer-related symptom assessment in France: validation of the French M. D. Anderson Symptom Inventory. J Pain Symptom Manage 39(4): 721-733, 2010.
Nejmi M, Wang XS, Mendoza TR, Gning I, Cleeland CS. Validation and application of the Arabic version of the M. D. Anderson Symptom Inventory in Moroccan patients with cancer. J Pain Symptom Manage 40(1): 75-86, 2010.
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.
Wang XS, Laudico AV, Guo H, et al. 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.
Yun YH, Mendoza TR, Kang IO, et al. Validation study of the Korean version of the M. D. Anderson Symptom Inventory. J Pain Symptom Manage 31(4): 345-352, 2006.
Ivanova MO, Ionova TI, Kalyadina SA, et al. 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.
Mystakidou K, Cleeland C, Tsilika E, et al. Greek M. D. Anderson Symptom Inventory: validation and utility in a cancer patient population. Oncology 67: 203-210, 2004.
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.
Okuyama T, Wang XS, Akechi T, et al. Japanese version of the M. D. Anderson Symptom Inventory: a validation study.J Pain Symptom Manage 26(6): 1093-1104, 2003.
Clinical Application
Kuang Y, Jing F, Sun Y, et al. Symptom networks in older adults with cancer: a network analysis. J Geriatr Oncol 15(3):101718, 2024.
Kirkova J, Davis MP, Walsh D, et al. Cancer symptom assessment instruments: a systematic review. J Clin Oncol 24(9):1459-1473, 2006.
Zhang X, Zhang H, Zhang Z, et al. The mediating effect of resilience on the relationship between symptom burden and anxiety/depression among Chinese patients with primary liver cancer after liver resection. Patient Prefer Adherence 17:3033-3043, 2023.
Coombs LA, Neller S, Wilson C, et al. Treatment decision conversations, symptoms, and functional status in older adults with advanced cancer: An exploratory study utilizing mixed methods. J Geriatr Oncol 14(2):101414, 2023.
Ekhator C, Rak R, Tadipatri R, et al. A single-center experience of dopamine antagonist ONC201 for recurrent histone H3 lysine 27-to-methionine (H3K27M)-mutant glioblastoma in adults. Cureus 14(8):e28175, 2022.
Castro-Figueroa EM, Torres-Blasco N, Rosal MC, et al. Brief report: Hispanic patients' trajectory of cancer symptom burden, depression, anxiety, and quality of life. Nurs Rep 11(2):475-483, 2021.
Ambai VT, Singh V, Boorman DW, Neufeld NJ. Celiac plexus neurolysis for abdominal cancers: going beyond pancreatic cancer pain. Pain Rep 6(1):e930, 2021.
Wyatt G, Lehto R, Guha-Niyogi P, et al. Reflexology and meditative practices for symptom management among people with cancer: results from a sequential multiple assignment randomized trial. Res Nurs Health 44(5):796-810, 2021.
Wang XS, Cleeland CS, Mendoza TR, et al. Impact of cultural and linguistic factors on symptom reporting by patients with cancer. J Natl Cancer Inst 102(10):732-738, 2010.
Shi Q, Trask PC, Wang XS, et al. Does recall period have an effect on cancer patients' ratings of the severity of multiple symptoms? J Pain Symptom Manage 40(2):191-199, 2010.
Did You Know?
MDASI Modules
MDASI modules augment the 19 core MDASI symptom and interference items with additional symptoms that are unique to a particular patient population.
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MDASI-AML/MDS
Acute Myeloid Leukemia/Myelodysplastic Syndrome Module
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MDASI-Breast
Breast Cancer Module
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MDASI-BT
Brain Tumor Module
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MDASI-CAR
Chimeric Antigen Receptor Module
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MDASI-cGVHD
Chronic Graft-versus-Host Disease Module
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MDASI-CLL
Chronic Lymphocytic Leukemia Module
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MDASI-CML
Chronic Myeloid Leukemia Module
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MDASI-EPT
Early-Phase Trials (Immunotherapy) Module
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MDASI-ESO
Esophageal Cancer Module
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MDASI-GI
Gastrointestinal Cancer Module
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MDASI-GIST
Gastrointestinal Stromal Tumor Module
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MDASI-HF
Cancer with Heart Failure Module
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MDASI-HN
Head and Neck Cancer Module
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MDASI-LC
Lung Cancer Module
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MDASI-MM
Multiple Myeloma Module
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MDASI-MPM
Malignant Pleural Mesothelioma Module
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MDASI-OC
Ovarian Cancer Module
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MDASI-PERIOP-HEP
Perioperative Hep Module
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MDASI-SP
Spine Tumor Module
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MDASI-TCM
Traditional Chinese Medicine Module
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MDASI-Thy
Thyroid Cancer Module
We are developing brief ‘fit-for-purpose’ patient-reported outcomes questionnaires that capture a patient's symptoms, their severity and their interference with functioning and quality of life.
Charles S. Cleeland, Ph.D.
Professor, Symptom Research
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Research Areas
Find out about the four types of research taking place at UT MD Anderson.