Quality of Life Research

, Volume 21, Issue 7, pp 1255–1266 | Cite as

The anemia impact measure (AIM): development and content validation of a patient-reported outcome measure of anemia symptoms and symptom impacts in cancer patients receiving chemotherapy

  • Leah Kleinman
  • Katy Benjamin
  • Hema Viswanathan
  • Maria Stoeckl Mattera
  • Linda Bosserman
  • Douglas W. Blayney
  • Dennis A. Revicki



To develop a patient-reported outcome instrument for measuring anemia symptoms and their impact in patients with chemotherapy-induced anemia (CIA).


Qualitative research was conducted using six focus groups and 24 interviews with 46 CIA patients, eight interviews in patients receiving chemotherapy with no CIA history and two interviews in patients successfully treated for CIA. Atlas.ti 5.0 was used to organize key concepts. Cognitive interviews with 16 CIA patients and assessment of relevance of each item to CIA by 10 clinicians were also conducted to evaluate content validity.


Most CIA patients were white (76%) and female (83%), and the average age was 60 years. The most common cancer types were breast cancer (54%) and lung cancer (17%). Tiredness was the most prevalent symptom and rated as the most important by 83% of CIA patients; weakness, shortness of breath, lightheadedness, and dizziness were ranked next in importance. The final anemia impact measure (AIM) contains: (1) daily CIA symptom diary (9 items), and (2) impact of CIA-related tiredness (29 items covering daily living activities, social activities, cognitive function, and emotions). Cognitive interviews found that the AIM was relevant and easy to understand.


The AIM assesses important patient-perceived CIA symptoms and their impact and was developed using extensive patient qualitative data.


Chemotherapy Anemia Symptom Instrument development Content validity Qualitative research 



Activities of Daily Living


Anemia Impact Measure


Chemotherapy-Induced Anemia


Electronic Personal Digital Assistant


Functional Assessment of Cancer Therapy-Anemia


Functional Assessment of Cancer Therapy-Fatigue


Food and Drug Administration




Health-Related Quality of Life


Instrumental Activities of Daily Life


Mental Component Summary Score


National Institutes of Health


Physical Component Summary Score


Personal Digital Assistant


Patient-Reported Outcomes


Standard Deviation



The authors thank Mona Martin, RN, MPA, and the research group at Health Research Associates, Inc. for an independent analysis of the data and comments on an earlier draft. The authors thank both Joel Kallich at Amgen Inc. for reviews of the protocol and manuscript and Linda Runft at Amgen Inc. for editorial assistance on the manuscript. The authors also wish to extend their acknowledgment to David Henry, MD; Heinz Ludwig, MD; Barbara Piper, DNSc, RN, AOCN, FAAN, and Lee Schwartzberg, MD, who served as members of the expert panel for their extensive input during the conceptualization and implementation of the instrument development study. Panel members participated in meetings with the authors during protocol development and during the study to discuss the recording and graduation of anemia symptoms and the difficulties in discriminating anemia symptoms from symptoms due to cancer and cancer therapy.

Supplementary material

11136_2011_34_MOESM1_ESM.doc (106 kb)
Supplementary material 1 (DOC 106 kb)


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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Leah Kleinman
    • 1
  • Katy Benjamin
    • 1
  • Hema Viswanathan
    • 2
  • Maria Stoeckl Mattera
    • 1
  • Linda Bosserman
    • 3
  • Douglas W. Blayney
    • 4
  • Dennis A. Revicki
    • 1
  1. 1.Outcomes Research, United BioSource CorporationUnited BioSource CorporationBethesdaUSA
  2. 2.Amgen, Inc.Thousand OaksUSA
  3. 3.Wilshire Oncology Medical GroupRancho CucamongaUSA
  4. 4.Stanford Cancer CenterStanfordUSA

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