et al 1 share results from a single-institution prospective, observational cohort study (NCT04624477) investigating the association between self-reported gender (treated as a binary variable) and fears associated with treatment options for low-risk papillary thyroid cancer (PTC). The 200 enrolled participants (153 women; 47 men) with untreated, clinically low-risk PTC (defined as <2 cm and confined to the thyroid) completed validated and original measures assessing fear of disease progression, fear of surgery, and thyroidectomy-specific fears prior to being offered surgery or active surveillance (AS). All participants had a surgical consultation to discuss the recommended extent of surgery and potential complications. Overall, 78% of participants chose AS, with no gender-related differences in treatment choice. However, enrolled participants who identified as women were significantly younger, and both age and gender were associated with fear of progression and fear of surgery on unadjusted models. After adjusting for age, those identifying as women had greater fear of surgery compared with men, but similar fears of progression and thyroidectomy-related fears. These findings are congruent with the similar rate of enrollment in AS by gender and have notable implications for patients and clinicians. Decisional confidence and self-efficacy were also evaluated, but no differences were seen.When considered in the context of prior research in this area, the study by Sawka et al 1 adds novel insights about the intersection of gender, fear, and treatment choice in patients with lowrisk thyroid cancer. Recently, the evaluation of patient emotions, such as fear, related to thyroid cancer diagnosis, treatment choice, and survivorship has garnered increased attention. 2 This attention comes in the wake of modern models of decisionmaking that recognize (1) the strong influence that emotions have on human judgment, and (2) the potential for emotions such as fear to drive seemingly irrational behavior that could result in unwanted outcomes. For example, data show that despite an excellent prognosis, survivors with favorable, low-risk thyroid cancer experience significant worry about disease recurrence, which can impair quality of life. 3 Gender effects must also be considered in relation to sex-based disease disparities. The prevalence of thyroid cancer remains 3 times higher in women who are more likely to be diagnosed with small PTCs. 4 Despite these differences, limited investigation exists into how sex and gender influence thyroid cancer-related information processing and decision-making.The results of the study by Sawka and colleagues 1 have important implications for patients and surgeons navigating complex treatment decisions. Fear of surgery naturally provides motivation for patients to prefer nonsurgical management options such as AS. At the same time, fear and anxiety associ-
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