Two widely used ways to measure how much cancer and its treatment weigh on a patient, symptom by symptom, on 0 to 10 scales. Run either on participants' phones between visits, when symptoms happen.
Free sandbox · No credit card · 21 CFR Part 11 aligned
Symptom check
Rate each symptom now, 0 to 10
Pain
Tiredness
Nausea
At a glance
Compared
| MDASI | ESAS-r | |
|---|---|---|
| Core symptoms | 13 (e.g. pain, fatigue, nausea, disturbed sleep, distress, shortness of breath) | 9 (pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, wellbeing) |
| Interference | 6 items (general activity, mood, work, relations, walking, enjoyment) | Not included |
| Scale | 0 to 10 | 0 to 10 |
| Recall | Past 24 hours | Now |
| Modules | Disease- and treatment-specific modules | Optional additional symptom |
| Typical setting | Clinical trials, symptom research | Palliative care, routine oncology, trials |
Obtain the instruments and permissions from their developers; use official wording and translations.
In trials
Symptoms change quickly during cancer treatment: fatigue peaks days after a cycle, nausea is worst in the first 48 hours, pain varies with disease and treatment. A questionnaire completed only at clinic visits misses most of that. Short numeric instruments like the MDASI and ESAS-r can be completed daily or several times a week in a couple of minutes, giving a picture of symptom burden across the whole cycle.
In Capture they run as recurring questionnaires in the participant's phone browser. Custom-value checks on the highest ratings can raise a query so the site knows when a participant reports severe symptoms, and the site can follow up and record adverse events where the investigator judges it appropriate.
When due
18:00
Your evening diary is open
Next day
18:00
Reminder: your diary is still open
Final notice
21:30
Last chance before the window closes
Quiet hours
22:00 to 08:00 in the participant's time zone
Stops
As soon as the task is completed
Build it in the sandbox and send yourself the participant link.
Symptom monitoring
Randomised studies of electronic symptom monitoring during chemotherapy have reported benefits for patients, including better quality of life, when severe symptoms were flagged to clinicians promptly. In a trial, the same approach improves safety oversight: a participant rating nausea or pain at 8 out of 10 on a Tuesday should not wait for the next cycle to be asked about it.
Decide in advance which ratings trigger follow-up, who is notified and how quickly, and how the follow-up is documented. In Capture, custom-value edit checks on the highest ratings raise a query for the site; the investigator then decides whether the symptom is an adverse event and records it on the AE log.
Analysis
Symptom burden data is usually analysed in several ways at once: mean scores for key symptoms and interference over time, the proportion of participants with moderate or severe ratings at each time point (many studies treat 5 or more on a 0 to 10 scale as moderate to severe and 7 or more as severe), and time to deterioration from baseline. Pre-specify which symptoms matter most for the treatment being tested, because testing every item invites multiplicity problems.
Frequent measurement is what makes these analyses possible, and it is also what makes missing data likely. Record why assessments were missed, particularly around hospital admissions and disease progression, when the sickest participants are the least likely to answer. See PRO-CTCAE for patient-reported adverse event measurement alongside symptom burden.
Before go-live
MDASI permission from MD Anderson; ESAS-r terms checked.
Past 24 hours or now, collected at a consistent time.
Which ratings raise a query and who reviews.
Disease-specific items for MDASI if needed.
For non-English speaking participants.
Weekly review of missed entries.
It depends on the question. Weekly is common during active treatment; daily ratings suit short, intense periods such as early chemotherapy cycles. Match the recall period to the frequency.
Many studies treat 5 or more on a 0 to 10 scale as moderate to severe and 7 or more as severe. Pre-specify the thresholds in the analysis plan.
The MD Anderson Symptom Inventory, rating 13 core cancer symptoms and six interference items from 0 to 10 over the past 24 hours.
The revised Edmonton Symptom Assessment System, rating nine common symptoms from 0 to 10 at the time of completion.
MDASI adds interference items and disease modules; ESAS-r is shorter and common in palliative care. Choose by population and endpoint.
The MDASI is copyrighted and requires permission from MD Anderson. Check current terms for ESAS-r with its developers.
Yes, as recurring questionnaires in the phone browser, with reminders.
Daily symptom checks on participants' phones. Free sandbox.