Section of Supportive Hospice and Palliative Medicine

Department of Family and Community Medicine

University of the Philippines Philippine General Hospital
Manila

SHPM PROGRAM DOCUMENT (CFAT 012011-14)

COMPENDIUM OF FILIPINO ASSESSMENT TOOLS FOR CLINICAL PRACTICE & RESEARCH

MD ANDERSON SYMPTOM INVENTORY (MDASI)

AUTHOR/S: Department of Symptom Research, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
FILIPINO VERSION: The original English Version was translated and validated in Filipino (Tagalog).
PURPOSE: To assess the severity of multiple symptoms and the impact of symptoms on daily functioning
DESCRIPTION: The MDASI is a brief, simple, and easy to use tool for the assessment of multiple symptoms in both clinical and research
settings. Symptoms produced by the cancer itself or the disease treatment collectively impose a symptom burden upon the patient.
Symptom burden is the sum of the severity and impact of symptoms reported by a significant proportion of patients with a given disease or
treatment. The MDASI aims to address the need to assess multiple symptoms simultaneously to determine symptom burden. The original
MDASI (English) has been validated in a sample of cancer patients at M. D. Anderson. In the Philippines, cancer patients and communitydwelling adults participated in a cross-sectional validation study of the Filipino version of the M. D. Anderson Symptom Inventory.
SCORING: In Part 1, the Symptom Scale, (13 items), MDASI assesses a concise set of symptoms that are applicable to most patients with
cancer. In Part 2, the Interference Scale, (6 items) it asks patients to rate how severely their symptoms interfere with physical and affective
functional domains. The MDASI assesses the severity of symptoms at their worst in the last 24 hours on a 010 scale, with 0 being not
present and 10 being as bad as you can imagine. A Global Symptom Score can be obtained by taking the average of the 13 symptom items
(sum of 13 symptoms divided by 13). A prorated Total Score can also be obtained when patients score at least 7 of the 13 items using the
formula: (sum of items answered) x 13 / number of items answered. Global and Total Scores can also be obtained for the Interference Scale.
RELIABILITY: In the original MDASI (English) study, 2 factors (2 sets of symptoms: general and gastrointestinal symptoms) were
determined from the 13 symptom items (Part 1). Cronbach alpha values for the 2 sets of symptoms and the interference scale (Part 2) were
calculated for both the validation and cross-validation samples. The alpha for the two sets of symptoms and the interference scales (Part 2),
respectively, were 0.85, 0.82, and 0.91 for the validation sample and 0.87, 0.87 and 0.94 for the cross-validation sample, which shows a high
level of reliability for these sets of items. In the original Filipino MDASI study, both exploratory factor analysis and hierarchical cluster
analysis also revealed the same two underlying symptom severity constructs consistent with the English version of the MDASI. Cronbach
alpha coefficients of 0.79 and 0.77, respectively, demonstrated acceptable internal consistency for the two factors.
VALIDITY: The original MDASI (English) has been used in several validation studies. For the Filipino MDASI, known-group validity was
confirmed by significant differences on MDASI items by performance status (P<0.01 or P<0.001). Fatigue, sadness, distress, and pain were
significant predictors of symptom interference. Cancer patients reported significantly greater symptom severity on multiple items than did the
community sample. Further validation studies of the MDASI and its many translations are ongoing and planned by the author/s of the tool.
PRIMARY REFERENCES: 1) Original MDASI Article: Cleeland CS, Mendoza TR, Wang XS, Chou C, Harle M, Morrissey M, Engstrom
M. (2000). Assessing symptom distress in cancer patients: the M. D. Anderson Symptom Inventory. Cancer. 89: 1634-1646. 2) Filipino
MDASI Article: Wang XS, Laudico AV, Guo H, Mendoza TR, Matsuda ML, Yosuico VD, Fragante EP, Cleeland CS. (2006). Filipino
version of the M. D. Anderson Symptom Inventory: validation and multisymptom measurement in cancer patients. J Pain Symptom Manage.
31(6):542-52.
In addition to the primary reference, this document can be cited as follows: M. Medina and the Section of Supportive Hospice and Palliative
Medicine (SHPM). MD Anderson Symptom Inventory (MDASI). SHPM Program Document. Compendium of Filipino Assessment Tools for
Clinical Practice & Research (CFAT 012011-14). SHPM, DFCM, UP-PGH. 2011.
AVAILABILITY: Permission to use the MDASI should be obtained from the author/s and copyright holder. The Department of Symptom
Research, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, Texas 77030. Tel. (713)
745-3805. Email: swong@mdanderson.org. To obtain permission to use this assessment tool, you must agree not to alter it in any way or to
translate it into another language. Fees may apply.

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