What is the most important late effect monitoring issue related to doxorubicin?

• A. Nausea
• B. Cardiovascular toxicity risk related to cumulative dose
• C. Myelosuppression
• D. Alopecia

Answer: (B)

Doxorubicin carries a risk of damage to the heart that increases with the total amount given over a patient’s lifetime, and this damage can appear or progress long after therapy ends. Because of that, the most important late effect to monitor is cardiovascular toxicity related to cumulative dose. The heart may develop dose-related cardiomyopathy and heart failure years later, which makes ongoing cardiac assessment essential. Clinically this means baseline and periodic evaluation of cardiac function (for example, left ventricular ejection fraction by echocardiography or other imaging), watching for symptoms such as shortness of breath, fatigue, or edema, and keeping track of the total lifetime dose to guide prevention strategies or dose adjustments.

Nausea and alopecia are typically acute or reversible effects during treatment, and myelosuppression is a hematologic toxicity that occurs during therapy rather than as a late effect.