Electronic patient-reported outcomes (ePROs) have shown real promise in oncology — helping catch symptoms, treatment toxicities, and social needs that might otherwise go unnoticed between clinic visits. But a new perspective from two oncology informatics leaders argues that the field has been asking the wrong question. It's not can we collect ePROs at scale — it's can we make them matter?

At one major cancer center, over 5.9 million questionnaires were sent and 3 million completed between 2016 and 2023, with 73% of assigned patients completing at least one. Yet even that robust program was nearly derailed by an EHR transition — a reminder that scale without infrastructure is fragile. The authors argue that most ePRO programs remain "parallel" to care: they collect data without changing decisions, generate alerts without clear ownership, and duplicate efforts across research, quality, and clinical teams.

The fix, they say, is treating ePROs as shared care-delivery infrastructure — not isolated projects. That means six aligned elements working together: centralized governance, workflow-first design, closed-loop clinical action, alignment with existing initiatives, equitable patient-centered design, and continuous data-driven learning.

Key Takeaways:

• A symptom alert is only useful if someone is accountable for acting on it — closed-loop workflows with defined roles and escalation paths are essential
• Questionnaire libraries should be governed centrally to reduce patient fatigue and clinician burden from duplicated assessments
• Equity matters: multilingual content, mobile access, and branching logic can reduce participation gaps across patient populations

Why it matters: Patients are already telling their care teams what they're experiencing. The challenge now is building oncology systems that are actually designed to listen, respond, and learn — turning ePROs from a data-collection exercise into a genuine care intervention.