Elizabeth Cash

Mindfulness meditation alleviates fibromyalgia symptoms in women: results of a randomized clinical trial.

BackgroundSeveral recent reviews have evaluated evidence on the efficacy of Mindfulness-Based Stress Reduction (MBSR) among fibromyalgia sufferers, and concluded that more research should test effects on both psychological and physiological functioning.PurposeWe conducted a randomized prospective trial of MBSR among female fibromyalgia patients.MethodsEffects on perceived stress, pain, sleep quality, fatigue, symptom severity, and salivary cortisol were tested in treatment (n = 51) versus wait-list control participants (n = 40) using data at baseline, post-program, and 2-month follow-up.ResultsAnalyses revealed that MBSR significantly reduced perceived stress, sleep disturbance, and symptom severity, with gains maintained at follow-up. Greater home practice at follow-up was associated with reduced symptom severity. MBSR did not significantly alter pain, physical functioning, or cortisol profiles.ConclusionMBSR ameliorated some of the major symptoms of fibromyalgia and reduced subjective illness burden. Further exploration of MBSR effects on physiological stress responses is warranted. These results support use of MBSR as a complementary treatment for women with fibromyalgia (ISRCTN: 34628811).

Circadian disruption and biomarkers of tumor progression in breast cancer patients awaiting surgery

Psychological distress, which can begin with cancer diagnosis and continue with treatment, is linked with circadian and endocrine disruption. In turn, circadian/endocrine factors are potent modulators of cancer progression. We hypothesized that circadian rest-activity rhythm disruption, distress, and diurnal cortisol rhythms would be associated with biomarkers of tumor progression in the peripheral blood of women awaiting breast cancer surgery. Breast cancer patients (n=43) provided actigraphic data on rest-activity rhythm, cancer-specific distress (IES, POMS), saliva samples for assessment of diurnal cortisol rhythm, cortisol awakening response (CAR), and diurnal mean. Ten potential markers of tumor progression were quantified in serum samples and grouped by exploratory factor analysis. Analyses yielded three factors, which appear to include biomarkers reflecting different aspects of tumor progression. Elevated factor scores indicate both high levels and strong clustering among serum signals. Factor 1 included VEGF, MMP-9, and TGF-β; suggesting tumor invasion/immunosuppression. Factor 2 included IL-1β, TNF-α, IL-6R, MCP-1; suggesting inflammation/chemotaxis. Factor 3 included IL-6, IL-12, IFN-γ; suggesting inflammation/TH1-type immunity. Hierarchical regressions adjusting age, stage and socioeconomic status examined associations of circadian, distress, and endocrine variables with these three factor scores. Patients with poor circadian coordination as measured by rest-activity rhythms had higher Factor 1 scores (R(2)=.160, p=.038). Patients with elevated CAR also had higher Factor 1 scores (R(2)=.293, p=.020). These relationships appeared to be driven largely by VEGF concentrations. Distress was not related to tumor-relevant biomarkers, and no other significant relationships emerged. Women with strong circadian activity rhythms showed less evidence of tumor promotion and/or progression as indicated by peripheral blood biomarkers. The study was not equipped to discern the cause of these associations. Circadian/endocrine aberrations may be a manifestation of systemic effects of aggressive tumors. Alternatively, these results raise the possibility that, among patients with active breast tumors, disruption of circadian activity rhythms and elevated CAR may facilitate tumor promotion and progression.

Persistent tracheostomy after primary chemoradiation for advanced laryngeal or hypopharyngeal cancer

Despite the demonstrated survival equivalence between chemoradiation and ablative surgery as primary treatment for advanced laryngeal and hypopharyngeal cancers, a subset of patients who undergo organ‐preservation therapy have persistent tracheostomy requirement after completion of treatment.

Impact of transcutaneous neuromuscular electrical stimulation on dysphagia in patients with head and neck cancer treated with definitive chemoradiation.

The purpose of this study was to investigate the role of transcutaneous neuromuscular electrical stimulation (TNMES) therapy in maintaining swallowing function during chemoradiation for locally advanced head and neck cancer.

Depressive symptoms predict head and neck cancer survival: Examining plausible behavioral and biological pathways: Depression and Head and Neck Cancer Survival

Head and neck cancers are associated with high rates of depression, which may increase the risk for poorer immediate and long‐term outcomes. Here it was hypothesized that greater depressive symptoms would predict earlier mortality, and behavioral (treatment interruption) and biological (treatment response) mediators were examined.

The relationship between central auditory processing, language, and cognition in children being evaluated for central auditory processing disorder

Background: Pediatric central auditory processing disorder (CAPD) is frequently comorbid with other childhood disorders. However, few studies have examined the relationship between commonly used CAPD, language, and cognition tests within the same sample. Purpose: The present study examined the relationship between diagnostic CAPD tests and “gold standard” measures of language and cognitive ability, the Clinical Evaluation of Language Fundamentals (CELF) and the Wechsler Intelligence Scale for Children (WISC). Research Design: A retrospective study. Study Sample: Twenty‐seven patients referred for CAPD testing who scored average or better on the CELF and low average or better on the WISC were initially included. Seven children who scored below the CELF and/or WISC inclusion criteria were then added to the dataset for a second analysis, yielding a sample size of 34. Data Collection and Analysis: Participants were administered a CAPD battery that included at least the following three CAPD tests: Frequency Patterns (FP), Dichotic Digits (DD), and Competing Sentences (CS). In addition, they were administered the CELF and WISC. Relationships between scores on CAPD, language (CELF), and cognition (WISC) tests were examined using correlation analysis. Results: DD and FP showed significant correlations with Full Scale Intelligence Quotient, and the DD left ear and the DD interaural difference measures both showed significant correlations with working memory. However, ∼80% or more of the variance in these CAPD tests was unexplained by language and cognition measures. Language and cognition measures were more strongly correlated with each other than were the CAPD tests with any CELF or WISC scale. Additional correlations with the CAPD tests were revealed when patients who scored in the mild–moderate deficit range on the CELF and/or in the borderline low intellectual functioning range on the WISC were included in the analysis. Conclusions: While both the DD and FP tests showed significant correlations with one or more cognition measures, the majority of the variance in these CAPD measures went unexplained by cognition. Unlike DD and FP, the CS test was not correlated with cognition. Additionally, language measures were not significantly correlated with any of the CAPD tests. Our findings emphasize that the outcomes and interpretation of results vary as a function of the subject inclusion criteria that are applied for the CELF and WISC. Including participants with poorer cognition and/or language scores increased the number of significant correlations observed. For this reason, it is important that studies investigating the relationship between CAPD and other domains or disorders report the specific inclusion criteria used for all tests.

Introduction to the Special Issue: Invited Papers from APAHC Award Honorees, 2013–2015

This special issue of the Journal of Clinical Psychology in Medical Settings (JCPMS) highlights the achievements and careers of seven distinguished psychologists whose work received special recognition during the time span of 2013–2015. They were chosen by the Awards Committee of the Association of Psychologists in Academic Health Centers (APAHC) to receive one of APAHC’s achievement awards. In 2013, there were three honorees: Drs. Cheryl King, Barry Hong, and Steven Tovian. The two honorees in 2014 were Drs. Mary Fristad and Edward Christophersen, and in 2015, there were two honorees: Drs. Richard Handel and William Robiner. Table 1 shows the seven award recipients categorized by the year and type of award they received. In planning this special issue, Guest Editors Drs. Alisia Tran and Liz Cash, in collaboration with JCPMS Chief Editor Dr. Jerry Leventhal, selected a format modeled after that used by the American Psychologist for its annual awards issue. The American Psychologist awards issue presents papers by recipients of awards granted by the American Psychological Association (APA) in that year. In keeping with The American Psychologist model, we invited each of the seven APAHC awardees to submit two articles, the first being an autobiographical personal statement about the development of their career as a psychologist and as a person. The second invited manuscript would be based on a topic of their choice based on some aspect of the honoree’s work. Thus, each APAHC award recipient was invited to contribute two separate manuscripts for this Special Issue, with the documents to be published together. The plan was to publish all 14 papers (seven authors, two papers per author) in this issue of JCPMS, but due to publication deadlines, some manuscripts may not appear until the next issue. Following the tradition established by the American Psychologist, each biographical article begins with a citation that is derived from documents submitted to the APAHC Awards Committee by sponsors who nominated each honoree. Drs. Barbara Cubic and William Robiner, who served as Presidents of APAHC and also chair of the APAHC Awards Committee, provided access to the nomination documents. We thank them for their assistance. Additionally, we gratefully acknowledge our debt to the American Psychologist and to APA. All articles, both biographies and ‘‘topic-of-choice’’ manuscripts, have undergone a peer review process and been assessed by three or more reviewers. Reviewers’ feedback was provided to each author for their manuscripts. We thank the reviewers for their work. In the next section we provide information about: APAHC as a professional association; JCPMS as APAHC’s official journal; the APAHC annual awards; and the three categories for which awards are given. We also & Elizabeth Cash liz.cash@louisville.edu

Depressive symptoms and actigraphy‐measured circadian disruption predict head and neck cancer survival

Depressive symptoms have demonstrated prognostic significance among head and neck cancer patients. Depression is associated with circadian disruption, which is prognostic in multiple other cancer types. We hypothesized that depressive symptoms would be associated with circadian disruption in head and neck cancer, that each would be related to poorer 2‐year overall survival, and that relationships would be mediated by tumor response to treatment.

Distress and quality of life in an ethnically diverse sample awaiting breast cancer surgery

Poor breast cancer–related quality of life is associated with flattened cortisol rhythms and inflammation in breast cancer survivors and women with advanced disease. We explored the associations of cancer-specific distress (Impact of Events Scale), mood (Profile of Mood States), activity/sleep (wake after sleep onset, 24-hour autocorrelation coefficient) and cortisol (diurnal slope) circadian rhythms, and inflammation (interleukin-6) with quality of life (Functional Assessment of Cancer Therapy–Breast) among patients awaiting breast cancer surgery (N = 57). Models were adjusted for differences in age and cancer stage. Distress and mood disturbance were significantly correlated with lower quality of life. Ethnic differences in the relationship between distress and mood disturbance with global quality of life and subscales of quality of life were observed. Actigraphic measures showed that in comparison with non-Hispanic patients, African Americans had significantly poorer activity/sleep (wake after sleep onset, 24-hour autocorrelation coefficient). Circadian disruption and inflammation were not associated with quality of life. Physiological dysregulation and associated comorbidities may take time to develop over the course of disease and treatment.

Introduction to the Special Issue: Invited Papers from the 2017 APAHC Conference

The 8th biennial national conference of the Association of Psychologists in Academic Health Centers (APAHC) was held in Detroit, MI, March 9–11, 2017. All speakers were invited to contribute manuscripts based on their conference presentations to this special issue of the Journal of Clinical Psychology in Medical Settings, and five presenters did so. All manuscripts were peer reviewed by experts in the field. The Conference Co-Chairs, Drs. Amy M. Williams and John A. Yozwiak, serve as Guest Editors for the special issue with Associate Editorial support from Dr. Elizabeth D. Cash. This article provides a brief overview of the rationale for the choice of the conference theme and the speakers, and a brief introduction to the articles in this special issue.