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
Lorch SA, Wade KC, Bakewell-Sachs S, Medoff-Cooper B, Silber JH, Escobar GJ. Antibiotic use in premature infants after discharge from the neonatal intensive care unit. Clin Pediatr (Phila). 2010 Apr;49(3):249-57. Epub 2009 May 15. Cited in PubMed: PMID 19448131. Read the abstract
Lorch SA, Baiocchi M, Silber JH, Even-Shoshan O, Escobar GJ, Small DS. The role of outpatient facilities in explaining variations in risk-adjusted readmission rates between hospitals. Health Serv Res. 2010 Feb;45(1):24-41. Epub 2009 Sep 24. Cited in PubMed: PMID 19780853. Read the abstract
Posters and Presentations
Silber JH, Lorch SA, Even-Shoshan O, Fager CE. Severity adjustment for assessing outcomes of transfer-in newborns [poster presentation]. Pediatric Academic Societies Annual Meeting; 2010 May; Vancouver, Canada.
Silber JH. Failure-to-rescue: theory and applications to congenital heart surgery [poster presentation], The Society of Thoracic Surgeons Congenital Heart Surgery Database Task Force; 2010 Jan 23; Fort Lauderdale, FL.
Silber JH, Rosenbaum PR, Brachet TJ, Ross RN, Lorch SA, Volpp KG. Misleading advice about AMI mortality from Medicare [presentation]. AcademyHealth Annual Research Meeting; 2009 Jun 29; Chicago, IL.
Neuman N, Fleisher LA, Even-Shohsan O, Mi L, Silber JH. Why didn’t that hip get fixed? Race & variations in operative & non-operative treatment for hip fracture [platform presentation]. AcademyHealth Annual Research Meeting; 2009 Jun 30; Chicago, IL.
Silber JH, Kaestner R. Dartmouth aggressive care & surgical outcomes [platform presentation]. AcademyHealth Annual Research Meeting; 2009 Jun 30; Chicago, IL.
Lorch SA, Srinivas SK, Silber JH, Fager C. The impact of obstetric unit closures on maternal and neonatal outcomes of pregnancy [platform presentation]. Pediatric Academic Societies Annual Meeting; 2009 May 2; Baltimore, MD.