Context of Gender May Influence Fears Related to Low-Risk PTC

Thyroid cancer of a woman, medically 3D illustration, front view: © Axel Kock - stock.adobe.com

Women with low-risk papillary thyroid cancer (PTC) had higher levels of surgical fear but not fear of the disease compared with men (after adjustment for age), but overall decisions between genders were not significantly different, according to findings from a single-center prospective cohort study.¹

There were also similar confidence levels between women and men regarding their choice of disease management and treatment and their decision of self-efficacy. These results show that the context of gender may affect the emotional experience of receiving a thyroid cancer diagnosis, as well as one's perception of treatment.

“In this cohort study of Canadian patients with low-risk PTC who were considering primary disease management options, our main finding is that women reported a higher level of surgical fear but not fear of the disease compared with men,” wrote study authors in findings published in theJAMA Otolaryngology–Head & Neck Surgery.

In the single-center, prospective cohort study conducted at a tertiary care referral hospital in Toronto, Canada, patients with untreated small low-risk PTC that was confined to the thyroid were included and all patients had a surgical consultation. Enrollment took place between May 2016 and February 2021, and data analysis was performed from December 16, 2022, to May 8, 2023.

The study included 153 women with a mean age of 50.7 years and 47 men with a mean age of 56.3 years (mean age difference, 5.6 years; Cohen d =.38; 95% CI, 0.05-0.71). No significant differences were noted in primary tumor size, marital status, education, parental status, or employment status between the men and women enrolled in the trial. A total of 78% patients chose to undergo active surveillance over surgery, with 78% of women and 74% of men choosing active surveillance (difference, 4%; 95% CI, -12% to 20%).

Patients with low-risk PTC self-reported their gender. These patients were offered the choice of thyroidectomy or active surveillance, and baseline data were collected before the patient decided on how to manage their disease.

Baseline patient questionnaires included the fear of progression-short form and surgical fear questionnaires that referred to thyroidectomy. After the adjustment for age, investigators compared the fears of women and men, as well as decision-related variables, including decision self-efficacy, and the ultimate treatment decisions.

Once the adjustment for age was made,no significant difference was seen in the level of fear of disease progression between men and women with PTC. The mean total fear of progression questionnaire score was 26.2 for women and 23.0 for men (difference, 3.2; Cohen d =.34; 95% CI, 0.01-0.68). However, there was a greater surgical fear observed in women vs men. Physical symptoms such as rapid heartbeat, stomachache, or agitation when anxious was more frequently noted by women compared with men (difference, 0.5; Cohen d =.39; 95% CI, 0.05-0.72). There were also greater fears regarding “severe medical treatments” during illness (Cohen d =.66) seen from women vs men, as well as not being able to work due to the illness (Cohen d =.31).

On the surgical fear questionnaire, the total score was significantly higher among women (mean, 34.1) vs men (mean, 22.0; difference, 12.1; Cohen d =.61; 95% CI, 0.28-0.95). More fear in response to questions on fears about surgery, anesthesia, postoperative adverse effects, pain, deteriorating health due to the operation, and the postoperative recovery/potential need for rehabilitation were also more frequently noted by women compared with men, and women also had more thyroidectomy-specific fears related to potential postoperative voice changes, hypocalcemia, and scar appearance.

However, there was no meaningful difference observed between women and men with respect to decision self-efficacy or the ultimate treatment choice. The responses of women and men were also similar regarding questions on the thyroid cancer treatment decision-making processes.

“In spite of the observed gender differences in surgical fears, women and men reported similar levels of confidence in medical decision-making and, in general, their treatment choices were not meaningfully different from those of men,” wrote the study investigators.

REFERENCE

Sawka AM, Ghai S, Rotstein L, et al. Gender differences in fears related to low-risk papillary thyroid cancer and its treatment [published correction appears in JAMA Otolaryngol Head Neck Surg. 2023 Sep 1;149(9):855]. JAMA Otolaryngol Head Neck Surg. 2023;149(9):803-810. doi:10.1001/jamaoto.2023.1642