Children's Hospital provides expert care for our patients with cancer, but nonetheless, long-term problems may develop. We are one of the original institutions that focused on the long-term consequences of care and are a leader in the field of caring for the delayed consequences of pediatric cancer treatment -- and I'm happy to be a part of this effort.
As part of the Cancer Survivorship Clinic team, I specialize in the delayed consequences of childhood cancer treatment, including cardiotoxicity (damage to the heart muscle) caused by chemotherapy and radiation therapy. I also look at the consequences of radiation on growth and development, including intellectual functioning and fertility. I have published extensively on the long-term effects of chemotherapy and radiation therapy, with a major focus on treatment-associated cardiotoxicity.
We have many patients who have survived cancer and we spend plenty of time with them in the survivorship clinic to get at whatever problems may be occurring. We try to determine a child's risk for having long-term problems and then we develop the best ways to prevent the problems or keep them from getting worse. For example, late cardiotoxicity after a form of chemotherapy called anthracycline therapy is frequent. To help prevent late cardiac toxicity after the therapy, we suggest routine monitoring of our children's heart functions. This helps detect any early changes. If found, we develop a treatment plan in concert with our cardiologists.
There are many unique aspects of long-term follow-up. When I see a patient who has been treated for cancer, I always work out the time when the treatment was received. This can impact their risk profile, since some effects are seen early on while others don't show up for decades. The age of the patient when they received the treatment is also important, since the same treatment at different ages can show different side effects. I also like to be clear on what treatment was received, the route of administration and any other chemotherapeutic drugs. Other factors also play a role in increasing the risk of cardiac dysfunction such as pre-existing cardiac disease, length of follow-up and gender.
My research involves cardiotoxicity caused by cancer treatment. I'm in a cardiac research group that is interested in finding more precise markers of ongoing cardiac cardiotoxicity to measure early treatment. This area of research has been my long-time interest. As a young physician, I had a patient who survived cancer but developed anthracycline cardiotoxicity. The idea that she was cured of her disease but developed this condition made me want to know why it happened and what we could do to help.
- Education and Training
Johns Hopkins University School of Medicine, Baltimore, Md.
John Hopkins Hospital, Baltimore, Md.
The Children's Hospital of Philadelphia, Philadelphia, Pa.
American Board of PediatricsAmerican Board of Pediatrics/Hematology-Oncology
University of Pennsylvania, Philadelphia, Pa.
- Titles and Academic Titles
Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania
- Departments and Services
- Research Interests
Silber JH, Rosenbaum PR, Kelz RR, Gaskin DJ, Ludwig JM, Ross RN, Niknam BA, Hill A, Wang M, Shoshan O, Fleisher LA. Examining causes of racial disparities in general surgical mortality: Hospital quality versus patient risk. Med Care 2015 (Accepted for publication).
Pimentel SD, Kelz RR, Silber JH, Rosenbaum PR. Large, sparse optimal matching with refined covariate balance in an observational study of the health outcomes produced by new surgeons. J Am Stat Assoc 2015. DOI:10.1080/01621459.2014.997879 [Epub ahead of print]. NIHMSID 659005; PMC Journal – In Process.
Pati S, Wong AT, Calixte RE, Ludwig J, Zeigler A, Localio AR, Moon J, Silber JH. Medicaid and CHIP retention among children in 12 states. Acad Pediatr 2015; 15:249-257. PMID: 25454028.
Silber JH, Rosenbaum PR, Ross RN, Niknam BA, Ludwig JM, Wang W, Clark AS, Fox KR, Wang M, Even-Shoshan O, Giantonio BJ. Racial disparities in colon cancer survival. A matched cohort study. Ann Intern Med 2014; 161:845-854. PMID: 25506853.
Patel MS, Volpp KG, Small DS, Hill AS, Even-Shoshan O, Rosenbaum L, Ross RN, Bellini L, Zhu J, Silber JH. Association of the 2011 ACGME resident duty hour reforms with mortality and readmissions among hospitalized Medicare patients. JAMA 2014; 312:2364-2373. PMID: 25490327.
Silber JH, Rosenbaum PR, Ross, RN, Ludwig JM, Wang W, Niknam BA, Saynisch PA, Even-Shoshan O, Kelz RR, Fleisher LA. A hospital-specific template for benchmarking its cost and quality. Health Serv Res 2014; 49:1475-1497. PMID: 25201167.
Silber JH, Rosenbaum PR, Ross RN, Ludwig JM, Wang W, Niknam BA, Mukherjee N, Saynisch PA, Even-Shoshan O, Kelz RR, Fleisher LA. Template matching for auditing hospital cost and quality. Health Serv Res 2014; 49:1446-1474. PMID: 24588413.
Forrest CB and Silber JH. Concept and measurement of pediatric value. Acad Pediatr 2014; 14:S33-8. PMID: 25169455.
Reese PP, Bloom RD, Feldman HI, Rosenbaum P, Wang W, Saynisch P, Tarsi NM, Mukherjee N, Garg AX, Mussell A, Shults J, Even-Shoshan O, Townsend RR, Silber JH. Mortality and cardiovascular disease among older live kidney donors. Am J Transplant 2014; 14:1853-1861. PMID: 25039276; PMC4105987.
Neuman MD, Silber JH, Magaziner JS, Passarella MA, Mehta S, Werner RM. Survival and functional outcomes after hip fracture among nursing home residents. JAMA Intern Med 2014; 174:1273-1280. PMID: 25055155; PMC4122620.