How and when to help children cope with trauma?
1
Editorial 600 www.thelancet.com Vol 381 February 23, 2013 The threat of lung cancer in European women The age-adjusted death rate from cancer in Europe will continue its downward trend in 2013, according to research published last week in Annals of Oncology. However, soon afterwards, a new and striking feature is predicted to emerge: by 2015, deaths from lung cancer in women could overtake those from breast cancer—the current leading cause of cancer death. Women’s lung cancer deaths show a clear inverse trend compared with most other cancers. Whereas deaths from gastric and uterine cancer have plummeted in the past four decades, and those from breast cancer have steadily declined since a peak in around 1990, deaths from lung cancer have continued a relentless upward trajectory, reflecting the devastating consequences of many women taking up smoking in the 1960s. Lung cancer death rates are almost three times higher for European men than for women, but the gap is closing. 5-year relative survival for lung cancer is poor in Europe—around 12%—and varies between countries. Survival in Denmark, the UK, and the Czech Republic is well below the European average. In another study published last week in Thorax, researchers used population data to try to drill down into some of the reasons for this international variation. Although differences in stage at diagnosis accounted for some of it, stage-specific survival also differed. Survival for TNM stage 1 disease in the UK was substantially lower than in Sweden, for example, suggesting that treatment (and population) differences also play a part. International comparisons such as these can help policy makers identify deficiencies in health-service provision, and should be given due consideration by governments across the region. Yet prevention remains the key to reducing the number of deaths from lung cancer. As the Million Women Study showed last month, smoking cessation before the age of 40 years can reduce the excess risk of lung cancer mortality by more than 90%. Approaches to stop smoking that target adult women would be an essential addition to existing policies to discourage uptake in young people. The Lancet For more on cancer death rates in Europe see Annals Oncol 2013; 4: 792–800 For more on cancer survival in Europe see Articles Lancet Oncol 2007; 8: 773–83 For more on international differences in lung cancer survival see Thorax 2013; published online Feb 11. http:// dx.doi.org/10.1136/ thoraxjnl-2012-202297 For the Million Women Study see Articles Lancet 2013; 381: 133–41 For the Valerie Forman-Hoffman and colleagues’ systematic review see Pediatrics 2013; published online Feb 11. DOI:10.1542/peds.2012-3846 In the long aftermath of atrocities such as the Newtown school massacre, families and health-care professionals are left trying to comprehend the incomprehensible. Thoughts duly turn to the future, and to prevention of such incidents, but what happens to the children left behind? How best to help them cope? The sobering answer, according to a systematic review published in Pediatrics last week, is that we do not know. Valerie Forman-Hoffman and colleagues had searched for high-quality studies that assessed interventions in children or adolescents exposed to non-relational traumatic events—including war, terrorist attacks, community violence, and natural disasters. Having boiled the available evidence down to just 22 short-term studies that tested 20 different treatments, they were left with worryingly vague conclusions. Drugs, it seems, probably don’t work. Only three were assessed—imipramine, fluoxetine, and sertraline— and none showed efficacy. Psychological treatments fared little better. Few showed clinical benefit (mainly school-based treatments that incorporated cognitive behavioural therapy), with the authors concluding, as strongly as available evidence would allow, that psychotherapeutic treatment might be more effective than no treatment at all. The authors call for more research into the comparative effectiveness of different interventions for this age group. But a focus on observational analysis of the long- term wellbeing of children and adolescents following a traumatic event would also be desirable. People cope with trauma in different ways. It is normal that extreme circumstances elicit extreme responses, but what is a normal reaction to a traumatic event? Without knowledge of the natural history of reaction to trauma, how do we know when to intervene, and when such intervention might be harmful? The answers will vary from child to child, although research might yet reveal general patterns that will be of use to clinicians. In the meantime, it is important that evidence-based support is available when necessary—which might be some time after the original traumatic event. The Lancet How and when to help children cope with trauma? Simon Fraser/Science Photo Library Mark Makela/Corbis
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Transcript of How and when to help children cope with trauma?
Editorial
600 www.thelancet.com Vol 381 February 23, 2013
The threat of lung cancer in European womenThe age-adjusted death rate from cancer in Europe will continue its downward trend in 2013, according to research published last week in Annals of Oncology. However, soon afterwards, a new and striking feature is predicted to emerge: by 2015, deaths from lung cancer in women could overtake those from breast cancer—the current leading cause of cancer death.
Women’s lung cancer deaths show a clear inverse trend compared with most other cancers. Whereas deaths from gastric and uterine cancer have plummeted in the past four decades, and those from breast cancer have steadily declined since a peak in around 1990, deaths from lung cancer have continued a relentless upward trajectory, refl ecting the devastating consequences of many women taking up smoking in the 1960s. Lung cancer death rates are almost three times higher for European men than for women, but the gap is closing.
5-year relative survival for lung cancer is poor in Europe—around 12%—and varies between countries. Survival in Denmark, the UK, and the Czech Republic
is well below the European average. In another study published last week in Thorax, researchers used population data to try to drill down into some of the reasons for this international variation. Although diff erences in stage at diagnosis accounted for some of it, stage-specifi c survival also diff ered. Survival for TNM stage 1 disease in the UK was substantially lower than in Sweden, for example, suggesting that treatment (and population) diff erences also play a part.
International comparisons such as these can help policy makers identify defi ciencies in health-service provision, and should be given due consideration by governments across the region. Yet prevention remains the key to reducing the number of deaths from lung cancer. As the Million Women Study showed last month, smoking cessation before the age of 40 years can reduce the excess risk of lung cancer mortality by more than 90%. Approaches to stop smoking that target adult women would be an essential addition to existing policies to discourage uptake in young people. The Lancet
For more on cancer death rates in Europe see Annals Oncol 2013;
4: 792–800
For more on cancer survival in Europe see Articles
Lancet Oncol 2007; 8: 773–83
For more on international diff erences in lung cancer
survival see Thorax 2013; published online Feb 11. http://
dx.doi.org/10.1136/thoraxjnl-2012-202297
For the Million Women Study see Articles Lancet 2013;
381: 133–41
For the Valerie Forman-Hoff man and colleagues’ systematic
review see Pediatrics 2013; published online Feb 11.
DOI:10.1542/peds.2012-3846
In the long aftermath of atrocities such as the Newtown school massacre, families and health-care professionals are left trying to comprehend the incomprehensible. Thoughts duly turn to the future, and to prevention of such incidents, but what happens to the children left behind? How best to help them cope? The sobering answer, according to a systematic review published in Pediatrics last week, is that we do not know.
Valerie Forman-Hoff man and colleagues had searched for high-quality studies that assessed interventions in children or adolescents exposed to non-relational traumatic events—including war, terrorist attacks, community violence, and natural disasters. Having boiled the available evidence down to just 22 short-term studies that tested 20 diff erent treatments, they were left with worryingly vague conclusions.
Drugs, it seems, probably don’t work. Only three were assessed—imipramine, fl uoxetine, and sertraline—and none showed effi cacy. Psychological treatments fared little better. Few showed clinical benefi t (mainly
school-based treatments that incorporated cognitive behavioural therapy), with the authors concluding, as strongly as available evidence would allow, that psychotherapeutic treatment might be more eff ective than no treatment at all.
The authors call for more research into the comparative eff ectiveness of diff erent interventions for this age group. But a focus on observational analysis of the long-term wellbeing of children and adolescents following a traumatic event would also be desirable. People cope with trauma in diff erent ways. It is normal that extreme circumstances elicit extreme responses, but what is a normal reaction to a traumatic event? Without knowledge of the natural history of reaction to trauma, how do we know when to intervene, and when such intervention might be harmful? The answers will vary from child to child, although research might yet reveal general patterns that will be of use to clinicians. In the meantime, it is important that evidence-based support is available when necessary—which might be some time after the original traumatic event. The Lancet
How and when to help children cope with trauma?
Sim
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Mar
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