LAUSR

Dyspnea is a subjective, yet complex experience of breathlessness, even in the absence of overt hypoxia. Although the pathophysiology of dyspnea is not fully understood, abnormalities of sensation in the brainstem, chest wall, and lungs play a role. Because of the limits of objective findings, many clinicians easily overlook this vital symptom. Air hunger can severely affect the quality of life of patients with advanced cancer. Estimates suggest that 70% of this patient population experiences dyspnea. Furthermore, almost 30% of patients report their dyspnea as being moderate to severe, according to the National Hospice Study. A recent review of 38 studies by the European Association for Palliative Care found a link between dyspnea and poor prognosis. Given the progressive nature of dyspnea and its impact on quality of life, the evaluation and treatment of this symptom require recognition and a multimodal approach. Recently, the American Society of Clinical Oncology (ASCO) published guidelines regarding managing dyspnea in patients with advanced cancer. The ASCO sought to recommend a hierarchal approach to dyspnea, starting with assessing the severity of dyspnea. After considering the severity of dyspnea, this guideline advocates for nonpharmacologic interventions first, followed by pharmacologic interventions for refractory symptoms.When possible, early palliative care consultation is helpful to help manage patients with dyspnea in advanced cancer. This perspective highlights five key points for primary care providers to consider when managing dyspnea in patients with advanced cancer based on the recent guideline published by the ASCO. We chose these key points, given the availability of the intervention to the patient and the primary care provider. Moreover, we prioritized interventions that would significantly improve the patient's mental and physical health, especially at the end of life.