Background: In clinical trials, RPM based on patient reported outcomes (PROs) has been shown to reduce symptom burden, increase dose intensity, improve quality of life and overall survival, and is recommended by international guidelines in routine oncology practice during systemic treatment (Di Maio et al., Ann Oncol 2022). Resilience developed a digital RPM system for oncology (CE marked, class IIa medical device) which prompts patients weekly with a notification to complete a survey including common symptoms from the NCI’s PRO-CTCAE questionnaire. Severe or worsening symptoms trigger an alert notification to the patient’s cancer care team, as well as personalized self-management advice, empowerment and educational material to patients. In this study we report the real-world implementation of Resilience RPM system in France and Belgium. Methods: Aggregated system-level metrics were collected covering all participating hospitals between Nov 2021 - Dec 2022. Qualitative and quantitative assessments focused on patient and provider utilization of Resilience RPM system was done. The implementation included a continued interaction between Resilience and hospital personnel for training, coordination and technical support. Results: 19 hospitals deployed Resilience in France and Belgium, including two Organization of European Cancer Institutes (OECI)-designated cancer centers and community oncology hospitals. Three integrated RPM with their electronic medical record. Overall, 1262 pts were registered (age range, 20-94), 40% with breast, 20% gastrointestinal and 8% genitourinary cancers. In the last 6 months, the main RPM interface was the mobile app (70%). Patient adherence with weekly RPM surveys was 85%, with a median time from prompt receipt to survey completion of 5h20min. RPM retention for 3 months, regardless of disease status, was 80%. Irrespective of severity, the most commonly reported PROs were performance status decline (94%), pain (89%) and anorexia (82%). The most common severe alert notifications were for nausea (33%), pain (31%) and anorexia (23%). The median time to alert management by the care team was 12h (70% within 24h), with 70% of alerts managed by a nurse navigator follow-up call, 5% by a referral for internal/external appointments, 0.5% with an emergency room referral and 0.4% with a hospitalization referral. 87% (32/38) of providers were satisfied with integrating the solution into their organization and 80% (30/38) felt patients were better managed through use of Resilience RPM. Conclusions: Implementation of the Resilience RPM system was feasible across a diverse group of 19 cancer centers in France and Belgium, with high levels of patient and provider participation and engagement. Resilience RPM offers an evidence-based approach to improve the quality and patient-centeredness of cancer care.