Background: Electronic patient-reported outcome (PRO) monitoring has been found to improve quality of life and overall survival in patients with metastatic cancer patients during active treatment. There has been limited data using PROs to enhance clinical outcomes in cancer survivorship. This pilot study of breast cancer survivors assessed utilization and satisfaction of proactive PRO symptom and adherence monitoring through an EHR patient portal (EPIC MyChart). Methods: Eighty breast cancer survivors who had completed surgery, chemotherapy, and/or radiation and received a survivorship care plan were randomized 1:1 either to usual care or PRO monitoring. The PRO group received questions from the NIH PROMIS toolkit through EPIC MyChart monthly between visits for 6 months. The triage nurse received an EPIC Inbasket alert if the survivor reported moderate to severe symptoms, had not taken their medication(s), or reported they would like to speak to a nurse. Participants in the control group were assessed for sadness, anxiety and satisfaction with provider communication at their usual follow visits. Results: Of 239 surveys sent out, 214 (90%) were completed. Eighty-five (36%) surveys triggered Inbasket alerts to the nurse. The most common nursing response to alerts was calling the patient for counseling/education. Compared to control, the PRO monitoring group exhibited no difference in satisfaction at 3 months, but had significantly higher scores at 6 months for satisfaction with communication (P=0.005) and monitoring (P=0.002). Anxiety scores did not differ between groups. Conclusions: Remote electronic monitoring of symptoms and adherence through the EHR bet was feasible with high completion rates, improved satisfaction, and did not increase anxiety in breast cancer survivors. Follow up work is assessing PRO monitoring to improve efficiency of following cancer survivors, and implementation of survivorship care plans.