Dr. Silliman is a geriatrician and clinical epidemiologist whose research over the past 20 years has highlighted age-associated disparities in cancer treatment, related in large part to the quality of patient- physician communication. Because of the critical role of comorbidity in the care of older cancer patients, her investigative work has also explored alternative methods of its measurement. Finally, her work has considered the implications of treatment variations on a range of health outcomes: (1) general and breast cancer-specific emotional health; (2) upper body function; and (3) breast cancer recurrence and mortality. Her currently funded R01s are designed to: (1) characterize the separate and joint effects of treatment, tumor, and patient characteristics on breast cancer-specific outcomes in the HMO setting; and (2) examine the relationships among breast cancer and its treatment, age-related comorbidities and functional impairments, and health outcomes in long-term older breast cancer survivors in the fee-for-service setting. During the K05 renewal period, Dr. Silliman proposes to study the impact of multiple morbidities on cancer care and outcomes. Specifically, she will (1) expand the scientific evidence that defines optimal breast cancer care for older women with multiple morbidities; (2) develop new measurement strategies and applications to improve our understanding of multiple morbidity as an independent variable, confounder, and effect modifier of breast cancer treatment and outcomes; (3) develop a research database infrastructure to support studies of cancer care quality and effectiveness among older cancer patients with multiple morbidities; and (4) develop young investigators whose research focuses on cancer prevention and control in older adults. New research during the funding period will compare the care for incident and prevalent non- breast cancer comorbid conditions, specifically quality of care and health care utilization; adherence to preventive health care strategies; and end of life care received by older breast cancer survivors and an age and comorbidity-matched comparison group. Relevance: Dr. Silliman has successfully applied the basic science of epidemiology to the cancer epidemic in older adults. She is positioned to enrich our knowledge of cancer prevention and control in older adults and to develop the next generation of cancer control scientists. ? ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Scientist Award (K05)
Project #
2K05CA092395-06
Application #
7097210
Study Section
Special Emphasis Panel (ZCA1-RTRB-L (J1))
Program Officer
Lohrey, Nancy
Project Start
2001-07-05
Project End
2011-06-30
Budget Start
2006-07-01
Budget End
2007-06-30
Support Year
6
Fiscal Year
2006
Total Cost
$148,568
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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