Goal: provide ready workflows for early detection and quick correction.
| Toxicity | Early signs | Evaluation | Management |
|---|---|---|---|
| Hot flushes | Sweating, insomnia | Assess frequency | SSRIs/SNRIs (citalopram, venlafaxine); gabapentin; lifestyle |
| Osteoporosis | DEXA T-score ≤ −2.0 | DEXA every 2 y | Bisphosphonate / Denosumab + Ca/Vit D |
| Fatigue | ↓ energy | Rule out anemia, hypothyroidism | Exercise, rest, treat cause |
| Metabolic syndrome | Weight gain, ↑ BP | Lipid/glucose profile | Diet/exercise, metformin/statins |
| Cognitive change | Forgetfulness | PHQ-9 / HADS | Cognitive training, SSRIs if depressive |
| Mood disorder | Irritability, depression | Screen PHQ-9 | Psychotherapy ± antidepressant |
| Sexual dysfunction | Libido ↓, ED, dryness | Detailed sexual history | PDE-5 inhibitors, moisturizers, counseling |
| Injection site pain | IM/SC redness | Clinical inspection | Ice, rotate sites, topical NSAID |
| Thromboembolism (Tamoxifen) | Leg swelling, pain | Doppler if suspicion | Anticoagulation; re-evaluate endocrine therapy |
| ONJ risk (bone agents) | Jaw pain, poor healing | Dental check | Stop agent temporarily, refer oral surgery |
Monitoring frequency summary
-
BP/Lipids/Glucose: q6 mo
-
DEXA: q24 mo (shorter if T ≤ −1.5)
-
LFT: q3 mo if on Abiraterone/Fulvestrant
-
Mood/Cognition: annually or symptom-triggered
(ASCO Supportive Care 2024; ESMO Survivorship 2025)
