Contents

Purpose

The MD Anderson Symptom Inventory (MDASI-BT) is a survey that patients will complete at time of tumor imaging to assess the severity of their brain tumor-related symptoms and the impact these symptoms have on their daily functioning. The MDASI-BT is completed using a paper-and-pencil form or an online form using a tablet or personal computer.

For some BTTC protocols, the MDASI-BT data will not be collected in C3D

MDASI-BT PART I eCRF

Part I : How severe are your symptoms.

Field Name

Description / Instructions

Format

Visit Date(m)

Enter the date the eCRF was completed

DD-MMM-YYYY

Date Questionnaire CompletedEnter the date on which a Quality of Life assessment was completed by the patient.

DD-MMM-YYYY

Questions 1-22

Enter the Severity Score to each "MD Anderson Symptom Inventory Brain Tumor related- Core Past 24 Hours Questions" based on 11 Point Likert Scale from 0 (symptom has not been present) to 10 (the symptom was as bad as you can imagine it could be) for each question.

Use pick list.

Legend: (d) derived field, (m) RDC mandatory, (c) for CTEP reporting only.

Validations

Code

Description

Resolutions

 

 

 

MDASI-BT PART II eCRF

Part II: How have your symptoms interfered with your life. 

Field Name

Description / Instructions

Format

Questions 23-28 

Symptoms frequently interfere with how we feel and function.Enter the Severity Score to each question from " How much have your symptoms interfered with the following items in the last 24 hours", based on 11 Point Scale from 0 (symptom did not interfere at all) to 10 (the symptom interfered completely) for each question.

Use pick list.

Legend: (d) derived field, (m) RDC mandatory

Validations

Code

Description

Resolutions

 

 

 
Last updated by Blackburn, Katie (NIH/NCI) [C] on Apr 18, 2017