Dr. Silliman is a geriatrician and clinical epidemiologist whose research most broadly described, has focused on chronic disease management in older adults. Over the past fifteen years, her breast cancer studies have been the core of this work. They have identified aspects of patient-physician communication as important factors in treatment decision-making, even after tumor characteristics, comorbidity, and functional status are taken into account. Dr. Silliman's investigative work has also explored alternative methods of comorbidity measurement and has considered the implications of treatment variations for a range of health outcomes: (1) general and breast cancer-specific emotional health; (2) upper body function; and (3) breast cancer recurrence and mortality. Dr. Silliman has also added to the small but growing body of observational study evidence that suggests that variations in breast cancer treatment do influence rates of breast cancer recurrence and mortality. Her currently funded R01 is designed to: (1) compare the effectiveness of adjuvant tamoxifen therapy, versus no adjuvant tamoxifen therapy, in reducing breast cancer recurrence and breast cancer mortality rates among older women receiving recommended definitive primary tumor therapies and those not receiving such therapies; (2) quantify the prevalence of tamoxifen discontinuance and identify patient and physician characteristics associated with it during the recommended five years of therapy; and (3) identify risk factors associated with a decline in health- related quality of life outcomes, particularly upper body function, during five years after breast cancer diagnosis. Dr. Silfiman's specific career objectives for the proposed award are: (1) to provide scientific evidence about breast cancer care and its consequences in older women, especially those > 75 years of age; (2) to apply new analytic techniques to existing data to control for confounding and misclassification in observational studies of breast cancer treatment; (3) to develop the research database infrastructure to study age-related variations in cancer treatment and outcomes among older cancer patients, applying the methods and experience developed studying breast cancer in older women to other common cancers (e.g., lung, colerectal, and prostate cancer) and, (4) to develop young clinical and non-clinical investigators whose research will focus on cancer prevention and control in older persons.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Scientist Award (K05)
Project #
5K05CA092395-02
Application #
6515201
Study Section
Subcommittee G - Education (NCI)
Program Officer
Lohrey, Nancy
Project Start
2001-07-05
Project End
2006-06-30
Budget Start
2002-07-01
Budget End
2003-06-30
Support Year
2
Fiscal Year
2002
Total Cost
$127,230
Indirect Cost
Name
Boston Medical Center
Department
Type
DUNS #
005492160
City
Boston
State
MA
Country
United States
Zip Code
02118
Eng, Jessica A; Clough-Gorr, Kerri; Cabral, Howard J et al. (2015) Predicting 5- and 10-year survival in older women with early-stage breast cancer: self-rated health and walking ability. J Am Geriatr Soc 63:757-62
Sehl, Mary; Lu, Xiang; Silliman, Rebecca et al. (2013) Decline in physical functioning in first 2 years after breast cancer diagnosis predicts 10-year survival in older women. J Cancer Surviv 7:20-31
Bosco, Jaclyn L F; Silliman, Rebecca A; Thwin, Soe Soe et al. (2010) A most stubborn bias: no adjustment method fully resolves confounding by indication in observational studies. J Clin Epidemiol 63:64-74
Hanchate, Amresh D; Clough-Gorr, Kerri M; Ash, Arlene S et al. (2010) Longitudinal patterns in survival, comorbidity, healthcare utilization and quality of care among older women following breast cancer diagnosis. J Gen Intern Med 25:1045-50
Clough-Gorr, Kerri M; Ganz, Patricia A; Silliman, Rebecca A (2010) Older breast cancer survivors: factors associated with self-reported symptoms of persistent lymphedema over 7 years of follow-up. Breast J 16:147-55
Clough-Gorr, Kerri M; Rakowski, William; Clark, Melissa et al. (2009) The Getting-Out-of-Bed (GoB) scale: a measure of motivation and life outlook in older adults with cancer. J Psychosoc Oncol 27:454-68
Mandelblatt, Jeanne S; Silliman, Rebecca (2009) Hanging in the balance: making decisions about the benefits and harms of breast cancer screening among the oldest old without a safety net of scientific evidence. J Clin Oncol 27:487-90
Bosco, Jaclyn L F; Lash, Timothy L; Prout, Marianne N et al. (2009) Breast cancer recurrence in older women five to ten years after diagnosis. Cancer Epidemiol Biomarkers Prev 18:2979-83
Gramling, Robert; Eaton, Charles B; Rothman, Kenneth J et al. (2009) Hormone replacement therapy, family history, and breast cancer risk among postmenopausal women. Epidemiology 20:752-6
Silliman, Rebecca A (2009) When cancer in older adults is undermanaged: the breast cancer story. J Am Geriatr Soc 57 Suppl 2:S259-61

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