Who stays engaged? Factors influencing compliance in an ePRO-based remote symptom monitoring program.

382 Background: Remote Symptom Monitoring (RSM) is a digital health approach aimed at improving cancer care by enabling patients to report symptoms regularly via electronic patient reported outcome measures (ePROs). This study examined monthly compliance and identified patient-level factors associated with sustained engagement in an ePRO-based RSM program. Methods: We analyzed data from 1,300 patients with cancer enrolled in an RSM program at the University of Alabama at Birmingham. Compliance was assessed over the first six months post-enrollment using two definitions: (1) For each month, a patient was assigned surveys, they were considered compliant if they submitted at least one survey within that month, and (2) For each month, a patient was assigned surveys, they were considered compliant if they submitted at least 65% of the surveys assigned during that month. Likelihood of compliance was estimated using repeated measures generalized estimating equations (GEE) with a Poisson distribution and log link to calculate relative risks (RRs) and 95% confidence intervals, adjusting for patient age, sex, race, cancer type, treatment type, disease stage, and residence (rural/urban). Results: Of 1,300 patients with cancer, median age was 61 (IQR 51 - 70), 65% were female, 69% were White, and 80% resided in an urban area. Breast (31%) cancer was the most common diagnosis, with the majority having received chemotherapy (64%). A total of 22,557 surveys were collected over six months. The proportion of patients with at least one survey sent per patient-specific month ranged from 99% in month 1 to 42% in month 6, indicating progressive disengagement over time. Using both compliance definitions 1 and 2, female sex was associated with 5% and 7% greater likelihood of compliance compared to males, respectively (RR 1.05, 95% CI 1.02–1.08; RR 1.07, 95% CI 1.01–1.15). Increasing age was also associated with 3% and 4% greater likelihood of compliance using definitions 1 and 2, respectively (RR 1.03, 95% CI 1.01–1.07; RR 1.04, 95% CI 1.02–1.09). Using definition 2, Black patients were less likely to be compliant compared to White patients (RR 0.93, 95% CI 0.88–0.98). Conclusions: Engagement with RSM declined over time and varied by demographic characteristics. Tailored outreach and support strategies are essential to promote inclusive participation and realize the full potential of RSM interventions.