95 Background: Although symptom assessment is a routine part of oncology care, data from the Michigan Oncology Quality Consortium (MOQC) showed variation in individual practice (Health Affairs 31:718, 2012). As part of the MOQC Palliative Care Demonstration Project, we implemented the Edmonton Symptom Assessment System(ESAS) in a private oncology clinic. ESAS is a valid and reliable assessment tool that evaluates nine common symptoms experienced by cancer patients. Our target population was patients with active cancer undergoing chemotherapy. Methods: Initial implementation focused on patients of only one of the practice’s physicians. Symptoms rated >3 were considered symptomatic and were addressed by the physician. To monitor overall performance, a practice profile was compiled from the individual ESAS results. For symptoms with the greatest severity and incidence, targeted resources were developed and integrated in new electronic medical record templates and educational sessions with patients. Results: Managing change incrementally with weekly reassessment of implementation problems was effective. Use of the ESAS tool allowed for a focused discussion of the patient symptomatology and lead to better efficiency for the physician. Understanding the symptom burden of the patient population and implementing practice wide interventions helped to reduce the symptom burden at an individual patient level. Conclusions: The ease of use of the ESAS tool makes it highly successful in the private oncology practice setting. Profiling the symptom burden at a practice level facilitates targeted improvements and monitoring of performance over time. [Table: see text]