Dr. Silliman has devoted her research career to understanding age-related disparities in cancer care and the
consequences of these disparities on cancer outcomes and health related quality of life. Dr. Silliman received her
MD and MPH degrees (health services) from the University of Washington in 1977. Following residency and chief residency
training in internal medicine at Brown University, she was selected as a Robert Wood Johnson Clinical Scholar at the
University of North Carolina. In addition to the research training received as part of the Clinical Scholars Program,
Dr. Silliman completed a Ph.D. in Epidemiology at the University of North Carolina School of Public Health in 1984.
Her training and experience in geriatric medicine, health services research, and epidemiology have equipped her to
translate and apply the basic sciences embodied in these disciplines to the clinical problems, particularly cancer,
in older adults.
As a junior faculty member at Brown University in the mid-1980's, Dr. Silliman was an investigator on its "Cancer
and Aging" study of newly diagnosed lung, breast, and colorectal cancer patients. Although this investigation found
that older lung, breast, and colorectal cancer patients in Rhode Island were no more likely to be diagnosed with
extensive disease than were younger patients, women 75 years of age or older with breast cancer were found to be less
likely than younger women to receive standard diagnostic evaluation and primary tumor therapy. In an associated study,
Dr. Silliman and colleagues found that physicians underestimated the importance that patients attached to
patient-physician communication and having information about their cancer and its treatment.
Dr. Silliman was the principal investigator of a cross-sectional study of newly diagnosed stage I and II breast
cancer patients 55 years of age or older, their involved family members, and their oncologic physicians at five
hospitals with academic affiliation in Boston, Massachusetts (1991 National Cancer Institute (NCI) RFA "Breast
Cancer Diagnosis, Management, and Sequelae in Older Women"). Two reports published in Cancer highlight the important
relationship between patient-physician communication and the receipt of primary tumor therapy as well as general and
breast cancer-specific emotional health outcomes. Dr. Silliman received funding in 1994 from the US Army Medical
Research Command to follow this cohort. Several reports from this follow-up study address methods to assess
comorbidity, risk factors for early and late decline in upper body function following initial therapy, and the role
of surgeon gender in the receipt of primary tumor therapy and systemic adjuvant therapy. More recent manuscripts
have addressed adjuvant tamoxifen use and discontinuance as well as patterns of breast cancer recurrence surveillance.
In 1996 Dr. Silliman was awarded new funding from the NCI, with co-funding from the National Institute on Aging,
for a multi-site study designed to identify predictors of physicians' prescription of tamoxifen and predictors of
patients' adherence to tamoxifen therapy. In June 2000 Dr. Silliman was awarded a new four-year grant from the NCI
to follow this cohort for an average of five years following diagnosis to answer critical questions about the
relationships between breast cancer treatments and disease-specific and health-related quality of life outcomes.
In recognition of her outstanding investigative and mentoring track record, Dr. Silliman recently (July 2001) received
an Established Investigator Award from the NCI. This five-year award supports Dr. Silliman's time to develop new
research initiatives and to mentor junior investigators.
In addition to her investigative work that focuses on breast cancer care, Dr. Silliman has had a long-stand interest
in the care of older patients with diabetes. She was a co-investigator on the Type II Diabetes PORT, funded by the
Agency for Health Care Policy and Research. This prospective longitudinal observational study of nearly 4,000 patients
cared for in three diverse health care settings studied the effectiveness of technical and interpersonal medical care
provided to type II diabetics. In addition, Dr. Silliman was principal investigator of a companion study to the Diabetes
PORT, funded by the Retirement Research Foundation that examined the role of family members in the day-to-day management
of diabetes among PORT study patients 70 years of age and factors associated with their participation in the medical
encounter. At present she is principal investigator of an Administration on Aging-funded project to improve the care of
older patients with diabetes and/or cardiovascular disease through the implementation of Wagner's Chronic Care Model in
the Geriatric Ambulatory Practice at Boston Medical Center. This project is collecting comprehensive biomedical and
functional information over a one-year period about a diverse (55% African American) group of older patients (n=410).
These data, as well as those collected in all of the above-described studies will be available for use by junior faculty
members supported by this award. Moreover, these junior faculty members would also have the opportunity to work with
Dr. Silliman and her investigative team on her ongoing projects as well as participate in the development of new projects
and associated grant applications.
Dr. Silliman actively mentors all Geriatric Medicine Fellows (three per year), a junior faculty member in the Department
of Epidemiology who is a K07 Award recipient, as well as doctoral and masters degree students in epidemiology. She also
serves as a co-investigator for the CREST Program (K30). The John A. Hartford Foundation-funded Center of Excellence in
Geriatrics provides additional mentoring opportunities with clinical faculty from other disciplines. As Chief of the
Geriatrics Section, Dr. Silliman actively supports the development of interdisciplinary collaborations in research. Her
own investigative team includes researchers with expertise in geriatrics and gerontology, health psychology, medical
oncology, pharmacoepidemiology, epidemiology, and biostatistics.
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