SMART-ER: Symptom Monitoring With Patient-reported Outcomes

• Inclusion Criteria:

• Female

• Age ≥ 18 years

• Able to read and understand English.

• Histologically confirmed stage I-III hormone receptor-positive invasive breastcarcinoma. Hormone receptor positivity is defined as estrogen receptor and/orprogesterone receptor ≥ 1% on any core biopsy or surgical specimen.

• Must be planning to initiate adjuvant endocrine therapy with tamoxifen or anaromatase inhibitor within the next 12 weeks. Patients are not eligible if they havealready initiated adjuvant endocrine therapy with tamoxifen or an aromataseinhibitor at the time of consent.

• Concurrent ovarian suppression with a luteinizing hormone releasing hormone (LHRH)or gonadotropin releasing hormone (GnRH) analog is allowed.

• Concurrent radiation therapy is allowed.

• Concurrent human epidermal growth factor receptor 2 (HER2)-targeted therapy isallowed.

• Completed all planned diagnostic and therapeutic breast and axillary surgicalprocedures.

• Must have an iPhone operating system (iOS - Apple iPhone) or Android smart phonethat they are able to use and download the Outcomes4Me app on.

• Must have ability to access the internet via their smart phone.

• Must be planning to receive follow-up medical oncology care at the study site forthe duration of the study. Patients seen for second opinion consultation who do notintend to follow-up at the study site for the duration of the study are not eligibleto participate.

• In addition to the above stated criteria, in order to be eligible to participate inthis study, an individual must meet at least one of the following criteriaassociated with higher risk for endocrine therapy non-adherence and/ornon-persistence:

• Age ≤40 years OR age ≥ 70 years.

• Self-identify as Black, African American or African.

• On medication for depression and/or anxiety.

• At least one of the following comorbid health conditions (mark all that apply):

• Congestive heart failure

• Valvular disease

• Pulmonary circulation disorder

• Peripheral vascular disorder

• Hypertension

• Paralysis

• Neurodegenerative disorder/Dementia

• Chronic pulmonary disease

• Diabetes

• Hypothyroid

• Renal disease

• Liver disease

• Peptic ulcer disease

• Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV) infection

• Rheumatoid arthritis/collagen vascular disease

• Coagulopathy

• Obesity

• Weight loss

• Fluid/electrolyte disorder

• Anemia

• Alcohol abuse

• Drug abuse

• Psychosis

• Depression

• Self-report one or more symptom of at least moderate severity, defined as ≥ 4 on a 0-10 point scale.

Study Team/Clinical Team Member Inclusion Criteria

• In order to be eligible to participate in this study, an individual must meet all ofthe following criteria:

• Provision of written informed consent.

• Stated willingness to comply with study procedures.

• A member of the study team or clinical team at a Johns Hopkins or VirginiaCommonwealth University clinical site where at least 2 patient participants haveenrolled, at least one of whom has passed the T2 survey time point and at least oneof whom has had an alert for a severe or worsening symptom.

• Able to participate in an interview in English.

Exclusion Criteria:

• Patients who have previously received tamoxifen and/or an aromatase inhibitor arenot eligible to participate.

• Patients initiating endocrine therapy for chemoprevention for high risk disease suchas lobular carcinoma in situ, ductal carcinoma in situ, atypical ductal hyperplasiaand/or atypical lobular hyperplasia in the absence of invasive breast carcinoma arenot eligible to participate.

• Receipt of chemotherapy is not allowed during study participation. Patients may havereceived chemotherapy prior to study participation in the study.

• Concurrent treatment with adjuvant abemaciclib is not allowed during studyparticipation.

• Concurrent treatment with adjuvant olaparib is not allowed during studyparticipation.

• Patients may not receive any investigational agent as part of a therapeutic clinicaltrial during participation in this study. Patients who previously received aninvestigational agent as part of a therapeutic trial and who are in follow-up forthe other therapeutic trial may participate in this trial.

• Patients may not participate in another trial evaluating an intervention to supportendocrine therapy adherence and/or persistence during participation in this study.

• Patients may not participate in another trial evaluating an intervention to monitoror manage symptoms during participation in this study.

Study Team Member Exclusion Criteria

• None