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Publications

Journal Article Research Support, Non-U.S. Gov't Ppublish 16 citations

PubMed: 37410454 DOI: 10.1001/jamaoto.2023.1642

Gender Differences in Fears Related to Low-Risk Papillary Thyroid Cancer and Its Treatment.

JAMA Otolaryngol Head Neck Surg 149(9):803-810

Authors: Anna M Sawka, Sangeet Ghai, Lorne Rotstein, Jonathan C Irish, Jesse D Pasternak, Patrick J Gullane, Eric Monteiro, Afshan Zahedi, Everton Gooden, Antoine Eskander, Janet Chung, Karen Devon, Jie Su, Wei Xu, Jennifer M Jones, Amiram Gafni, Nancy N Baxter, David P Goldstein

Affiliations

  • Division of Endocrinology, University Health Network and University of Toronto, Toronto, Ontario, Canada.
  • Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
  • Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada.
  • Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada.
  • Department of Otolaryngology and Head and Neck Surgery, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.
  • Division of Endocrinology, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada.
  • Department of Otolaryngology and Head and Neck Surgery, North York General Hospital and University of Toronto, Toronto, Ontario, Canada.
  • Department of Otolaryngology and Head and Neck Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada.
  • Department of Otolaryngology and Head and Neck Surgery, Trillium Health Partners and University of Toronto, Toronto, Ontario, Canada.
  • Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
  • Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
  • Department of Psychosocial Oncology, University Health Network and University of Toronto, Toronto, Ontario, Canada.
  • Centre for Health Economics and Policy Analysis, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
  • Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.

Abstract

Importance

Fear is commonly experienced by individuals newly diagnosed with papillary thyroid cancer (PTC).

Objective

To explore the association between gender and fears of low-risk PTC disease progression, as well as its potential surgical treatment.

Design, Setting, and Participants

This single-center prospective cohort study was conducted at a tertiary care referral hospital in Toronto, Canada, and enrolled patients with untreated small low risk PTC (<2 cm in maximal diameter) that was confined to the thyroid. All patients had a surgical consultation. Study participants were enrolled between May 2016 and February 2021. Data analysis was performed from December 16, 2022, to May 8, 2023.

Exposures

Gender was self-reported by patients with low-risk PTC who were offered the choice of thyroidectomy or active surveillance. Baseline data were collected prior to the patient deciding on disease management.

Main Outcomes and Measures

Baseline patient questionnaires included the Fear of Progression-Short Form and Surgical Fear (referring to thyroidectomy) questionnaires. The fears of women and men were compared after adjustment for age. Decision-related variables, including Decision Self-Efficacy, and the ultimate treatment decisions were also compared between genders.

Results

The study included 153 women (mean [SD] age, 50.7 [15.0] years) and 47 men (mean [SD] age, 56.3 [13.8] years). There were no significant differences in primary tumor size, marital status, education, parental status, or employment status between the women and men. After adjustment for age, there was no significant difference observed in the level of fear of disease progression between men and women. However, women reported greater surgical fear compared with men. There was no meaningful difference observed between women and men with respect to decision self-efficacy or the ultimate treatment choice.

Conclusions and Relevance

In this cohort study of patients with low-risk PTC, women reported a higher level of surgical fear but not fear of the disease compared with men (after adjustment for age). Women and men were similarly confident and satisfied with their disease management choice. Furthermore, the decisions of women and men were generally not significantly different. The context of gender may contribute to the emotional experience of being diagnosed with thyroid cancer and its treatment perception.

MeSH

Thyroid Cancer, Papillary, Disease Management, Fear, Neoplasms, Disease Progression, Cohort Studies, Thyroid Gland, Sex Characteristics, Thyroid Neoplasms, Therapeutics, Thyroidectomy, Sex Differences

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