Women more afraid of thyroidectomy, but not thyroid cancer progression, compared with men
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Key takeaways:
- Women report more fear of undergoing a thyroidectomy compared with men.
- Fear of disease progression did not differ between men and women.
Women with low-risk papillary thyroid cancer are more fearful of undergoing a thyroidectomy compared with men, according to findings from a single-center study published in JAMA Otolaryngology – Head & Neck Surgery.
“Gender-specific concerns may need to be considered in counseling of patients with small, low-risk papillary thyroid cancer about their disease management options,” Anna M. Sawka, MD, PhD, professor of medicine at University Health Network and University of Toronto in Canada, told Healio. “It is important to ask patients about any fears they may have related to their disease or its treatment. With respect to surgical fear, this may relate not only to fear about the procedure, but also its potential short- or long-term consequences. Surgical fears may be related to concerns about the implications on one's life role.”
Sawka and colleagues conducted a prospective cohort study enrolling 200 adults with small, low-risk papillary thyroid cancer who were offered either active surveillance or surgery from May 2016 to February 2021. Prior to deciding on cancer management, participants completed the Fear of Progression – Short Form and Surgical Fear questionnaires. Researchers asked four thyroidectomy-specific questions on potential voice change, requirement for thyroid hormone therapy, hypocalcemia and scar appearance. A higher score on all questionnaires indicated greater levels of fear. Adults completed the Decision Self-efficacy Scale to determine confidence in thyroid cancer management decision-making, with a higher score indicating more confidence.
The study group included 153 women and 47 men. Of the participants, 78% chose to have active surveillance instead of surgery.
In multivariable linear regression models, fear of disease progression decreased with older age (beta = –0.26; 95% CI, –0.34 to –0.17), but there was no difference in fear of disease progression between women and men. Men had lower scores for surgical fear than women (beta = –10.51; 95% CI, –16.97 to –4.05), and older age was associated with lower surgical fear scores (beta = –0.29; 95% CI, –0.47 to –0.1).
“There is some literature suggesting that preoperative anxiety, which is related to surgical fear, may be greater in women than in men,” Sawka said. “Thus, our findings complement some existing literature on preoperative anxiety, but our findings are specific to the context of surgery for small, low-risk papillary thyroid cancer.”
There was no difference between men and women in self-efficacy for deciding between active surveillance or surgery. Men and women had similar responses on questionnaires about the thyroid cancer treatment decision-making process. Scores for taking responsibility for the treatment choice were similar between women and men.
“It is important for our findings to be confirmed in other populations, including patients with other thyroid cancer or other thyroid cancer disease stages, as well as patients from other countries,” Sawka said. “It is also important to study more diverse gender identities.”
For more information:
Anna M. Sawka, MD, PhD, can be reached at annie.sawka@uhn.ca.
Perspective
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In their recent study, Sawka and colleagues conducted a comprehensive assessment of the fears associated with the diagnosis and management of low-risk papillary thyroid cancer among patients from a single Canadian referral center. In their cohort, patients with a new diagnosis of low-risk papillary thyroid cancer were subdivided into women and men, depending on their self-reported gender identity. Other than younger age in women, both subgroups were comparable in terms of baseline sociodemographics and tumor size. Younger patients had higher fear of disease progression and surgical intervention. Based on validated surveys, they found that women had higher fear of surgical intervention but similar fear of disease progression compared with men. However, both subgroups had a similar degree of confidence in the decision-making process and the ultimate treatment of choice (active surveillance or surgical management).
The strengths of the study include its prospective nature and the objective assessment of the fear of disease progression, surgical management and surgery-specific complications. However, the findings should be analyzed in the setting of the study’s limitations, which include the lack of stratification by racial diversity, nonbinary gender identities, socioeconomic status, type of insurance and accessibility to specialized medical care.
Considering the significant increase in the incidence of low-risk thyroid cancer over the last 3 decades, the disproportionate prevalence of thyroid cancer in women and the known role of emotions in clinical decision-making, the findings from Sawka and colleagues highlight the need to account for gender-specific fears during the counseling and decision-making process for these patients. This would be especially applicable to young patients who identify as women.
Additional research is needed to confirm these findings in other population settings and diverse types of thyroid cancer. It is essential to better characterize the psychosocial drivers behind the higher surgical fear in patients with low-risk papillary thyroid cancer who identify as woman. Furthermore, given that fear is multifactorial, there should be additional efforts to elucidate how fear manifests in patients with different cultural, racial and nonbinary gender backgrounds. Ultimately, these findings should translate into a better individualized, patient-centric approach, educational materials and support that accounts for our patients’ gender, racial, cultural and socioeconomic related fears and needs.
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