Virtually unheard of before the last decade, ES-NSCLC survivors have become part of a growing population. Currently comprising 15% of the 221,000 newly diagnosed lung cancers in 2011, the National Cancer Institute (NCI) cites improved screening and increased public consciousness in allowing the medical community to offer this group a chance of curative intervention; something practically nonexistent in lung cancer 5,6. Approximately 32% of these individuals have a stage I or II disease, the focus population for this article. Amounting to an approximately 50% five-year survival rate at stage IA–B, and averaging 30% for stages IIA–B 7–9, newly diagnosed patients with ES-NSCLC warrant treatment methods that employ an interdisciplinary approach. It is only through comprehensive assessment, interdisciplinary management and surveillance, that the palliative team will demonstrate sound clinical strategies, enhancing the QOL for these patients and their families 10. Often referred to as the 6th vital sign by leading authorities, dyspnea is defined as respiratory demand exceeding the body’s ability to meet that need 6,7,11. It is a subjective or perceived, sensory, varied, and yet common experience in lung cancer patients. It is associated with a conscious sensation of uncomfortable breathing, smothering or suffocating, difficult or labored breathing, inability to get enough air, or tightness in the chest 1,11. It differs from tachypnea (increased respirations) or breathlessness, which can be a normal physiological response as seen in exercise or a state of excitement 11. Dyspnea varies in intensity, consisting of an interface among physiological, psychological, social, and environmental factors, inducing secondary responses 11,12. In the clinical presentation chronic, labored breathing is one of the most difficult symptoms to identify or manage, and once acquired, it promises to remain an ever-present condition. Dyspnea possesses unique characteristics in that acute episodes, such as asthma or bronchitis, are manageable, and tend to subside and resolve with uncomplicated or minimal intervention of the underlying cause. Chronic cases are persistent, linger, and have varied intensity, regardless of intervention. In chronic dyspnea, 85% of the etiologies stem from cardiopulmonary and psychogenic causes 13. The American Thoracic Society (ATS) suggests the prevalence ranges from 55% – 87% in all stages of lung cancer. The sensation of breathlessness is frightening to patients and their caregivers (CGs) lending to a feeling of suffocation and possible death. Not only is dyspnea an alarming, multidimensional symptom, the impact on a patient’s QOL is undeniable and often incessant 4,11,14. Cognizant of the needs of these individuals, it is the palliative care nurse, possessing a specialized skill set, who is poised as the point person in coordinating care, and is a critical component of the interdisciplinary healthcare team. Along with the diagnosis of ES-NSCLC, 60% of these patients suffer co-morbid conditions and symptoms, such as COPD and dyspnea15. The plan of care should encompass pharmacological and non-pharmacological interventions for pre-existing medical concerns, along with those issues imposed by lung cancer or cancer treatments. Supportive and palliative care is an essential ingredient in ES-NSCLC patients with dyspnea. The following discussion addresses the etiology, assessment, management, and follow up for the symptom of dyspnea in ES-NSCLC patients.