Research Scholars Program – BIRCWH Mentors

Rebecca Silliman MD, PhD

Dr. Silliman is Professor of Medicine and Public Health, Boston University Schools of Medicine and Public Health and Director of Health Services Research for the Geriatrics Section at Boston Medical Center.

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.