Digital Symptom Monitoring Supports More Personalized Breast Cancer Care

Metastatic breast cancer, in which tumors spread to other organs, is incurable but increasingly managed with modern systemic therapies. As more treatments shift from hospital infusions to oral or at-home regimens, clinicians see patients less often and may miss early signs of toxicity or decline. This gap undermines timely interventions and quality of life. To help address this challenge, Charité–Universitätsmedizin Berlin has developed a digital patient‑reported outcomes model that pairs weekly app monitoring with rapid clinical follow‑up.

The PRO B digital treatment concept from Charité–Universitätsmedizin Berlin combines structured symptom self-reporting with alert-based outreach from the care team. The approach centers on electronic patient‑reported outcome monitoring to maintain close oversight between oncology visits. It aims to provide timely, individualized interventions without increasing routine hospital attendance.

At the core is a smartphone app that asks up to 52 structured questions every week about symptoms, daily activities, and emotional state. An algorithm analyzes responses and flags clinically relevant changes for the treating team. Clinicians then call patients within 48 hours to assess severity and determine next steps, such as supportive medication adjustments or expedited in‑person evaluation.

A Germany‑wide study evaluated PRO B across 52 breast cancer centers in 909 women with metastatic disease, aged 19 to 81, followed for one year. Approximately half received PRO B alongside drug therapy, while the comparison group answered well‑being questions only every three months and did not receive team-initiated contact. Findings were published in JAMA Oncology.

Patients receiving PRO B reported significantly less fatigue, which the study defined as a debilitating state of physical, emotional, or mental exhaustion. They also rated their physical functioning more positively and required fewer hospitalizations. More than 90% of participants in the PRO B group wanted the approach incorporated into routine care after the study concluded.

In June, Germany’s Federal Joint Committee (G‑BA) recommended integrating the PRO B concept into standard care, enabling access for patients with statutory health insurance following diagnosis. Health insurers involved in the project plan to offer routine access starting this fall under the name “ida,” led by the Charité team. The model is designed to continue as a structured blend of weekly digital monitoring and on‑demand clinical action.

"These are effects that have a noticeable impact on the patients' daily lives; the women are more capable and better able to manage their lives. We even have evidence that the PRO B approach extends the remaining lifespan for some patients. We are achieving all of this not through a new medication, but simply by regularly and systematically assessing the women's well-being and responding accordingly," said Maria Karsten, senior attending physician at the Charité Breast Cancer Center and initiator of the PRO B project.

"This recommendation must now be implemented as quickly as possible. If a new care concept offers medical and economic benefits, we should not withhold it from the most seriously ill women," stated PD Dr. Christoph Kowalski, department director at the German Cancer Society and co-author of the study.

Related Links
Charité–Universitätsmedizin Berlin
German Cancer Society