Book Review: Balancing Care: A Review of “Head and Neck Cancer Care in a Pandemic: Prioritizing Safe Care”

It is already easy to forget the sense of fear and anxiety that permeated our field in the early part of the COVID-19 pandemic. What has now become a slow grind of rippling surges and annoying unknowns was once a time of universal uncertainty and widespread panic. Reading this textbook feels like opening a time capsule, remembering our makeshift intensive care beds in our operating rooms, recalling lengthy debates over the safety and necessity of once simple procedures, and reliving the struggle to balance the safety of our community and the care of our head and neck patients. Head and Neck Cancer Care in a Pandemic aims to provide a sweeping overview of how the care of our complex and vulnerable patients was changed by this global pandemic and the ways to mitigate harm—for the patients in our clinic and the communities we all returned home to at night. This book was written at a time when we all still hoped that the world would someday go back to normal. Now that a new normal has started to reveal itself, and with the possibility of future pandemic scenarios, the book feels particularly prescient. While some of the information is now out of date with the advent of vaccines, which have drastically altered our protocols and institutional responses to the pandemic, this textbook serves as a useful reference for head and neck cancer providers in a still unsettled global health emergency. The book reads more like a collection of essays than a cohesive textbook. Many concepts, themes, and critical points arise in multiple chapters. For example, numerous chapters address the importance of not delaying necessary care, how and when to use personal protective equipment, the utility of testing, conserving resources, and the need for interdisciplinary teams to help make decisions in these complex situations. This redundancy is a strength of the book, given its likely use as a reference text. Another repeated theme is the need for protocols and clear procedures in times of uncertainty. Leaving it up to every individual physician to ration care, choose alternative treatments, or forgo standard treatments can lead to disparities in outcome, an inability to collect meaningful data and adjust processes, and lead to provider and healthcare team burnout and mental health issues, as detailed in the last section of the book. Many chapters provide excellent summaries of existing references, from expedited journal articles or society guidelines. They also note the importance of incorporating geographic and institution specific variation in local protocols and procedures. To this end, there are several useful summary tables and treatment algorithms that providers can reference, including a particularly helpful flowchart about the management of salivary neoplasms during a pandemic. One aspect of the book that surprised us was the assumption, reflected in several places throughout the work, that surgical treatment of disease is always the most resource intensive strategy when compared to radiation or chemotherapy or various imaging techniques for diagnosis. Others might point out that the frequent, sometimes daily, outpatient visits required for chemoradiation as well as the subsequent immunosuppression, make this questionable as a safer alternative to surgery for some patients. Other highlights of the book include the chapter on dying during a pandemic and the chapter on ethical considerations. The included vignettes on end-of-life care are upsetting, but moving, and are particularly helpful at crystallizing a lot of the information presented in other chapters. The section on ethics does an excellent job of elucidating the critical conflict in a pandemic, between bioethics and public health ethics, between the good of one or many, and contextualizing it in the care of our head and neck cancer patients. The book as a whole is thoughtful about recognizing the occasional gap between what we should do and what we can do. It succeeds in giving readers a framework to navigate that gap thoughtfully and safely. When possible, the text tries to address pandemics at large, and references other medical or natural disasters when useful. However, it’s impossible to ignore the very specific problem staring us in the face as otolaryngologists in this specific pandemic: this virus lives right in our territory. It seems tempting to pass off responsibility for this respiratory virus to our colleagues in the intensive care unit, emergency department, and infectious disease clinics. But the reality is 1136333 AORXXX10.1177/00034894221136333Annals of Otology, Rhinology & LaryngologyBook Review research-article2022