Prior to the COVID-19 pandemic, patients attending ambulatory clinics at cancer centers in Ontario completed the Edmonton Symptom Assessment Scale (ESAS) at each visit. At our center, completion was via touch pad, with assistance by clinic volunteers. As of March 2020, clinic appointments were conducted virtually when possible and touch pads removed. We anticipated a negative impact on the collection of patient-reported outcomes (PROs), and the recognition of severe symptoms. Methods: We performed a prospective cross-sectional cohort study to test the feasibility of remote ESAS completion by patients with appointments at a weekly surgical oncology clinic. Patients in the initial study cohort were asked to complete and return the ESAS virtually(V). Given low completion rates, the ensuing cohort was asked to complete a hard-copy(HC) ESAS. For the final cohort, we used an adaptive approach, providing remote, personal mentorship by a member of the care team to support virtual electronic ESAS completion (virtual-mentored(VM) cohort). Results: Between May-July 2020, a total of 174 patient encounters were included in the study. For the V cohort, 20/46 patients (44%) successfully completed and returned the electronic ESAS, compared to 49/50 (98%) for the HC cohort. For the VM cohort (n=78), the completion rate was 74%. Questionnaire completion was not predicted by age, sex or tumor site, although patients who completed the ESAS were more likely to be in active management rather than surveillance(p=0.04). Of all completed forms, 42% revealed a depression score ³2, and 27% an anxiety score ³4. Conclusions: We identified significant barriers to the virtual completion of ESAS forms, with a lack of predictive variables. The severe degree of psychological distress reported by ~50% of respondents demonstrates the need for ongoing regular collection/review of these data. Innovative solutions are required to overcome barriers to virtual collection of PROs.