Kristin Schroeder

Positions:

Assistant Professor of Pediatrics

Pediatrics, Hematology-Oncology
School of Medicine

Assistant Research Professor of Global Health

Duke Global Health Institute
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.P.H. 2002

West Virginia University

M.D. 2007

Georgetown University School of Medicine

Pediatric Internship and Residency

University of North Carolina, Chapel Hill, School of Medicine

Pediatric Hematology-Oncology Fellowship, Pediatrics Hem/Onc

Duke University School of Medicine

Pediatric Neuro-Oncology Fellowship, Tisch Brain Tumor Center

Duke University School of Medicine

Global Health Fellowship, Hubert Yeargen Center For Global Health

Duke University

Grants:

Stimulate Research in HIV/AIDS Cancer Research Projects at NCI-designated Cancer Centers

Administered By
Duke Cancer Institute
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

AIDS MALIGNANCY CONSORTIUM

Administered By
Pediatrics, Hematology-Oncology
Awarded By
University of California - Los Angeles
Role
Principal Investigator
Start Date
End Date

Publications:

EPV089/#619 Outcomes after establishment of a pilot cervical cancer navigation program at a tertiary Tanzanian academic hospital

Authors
Hari, A; Maillie, L; Schroeder, K; Yussuph, A
MLA Citation
Hari, A., et al. “EPV089/#619 Outcomes after establishment of a pilot cervical cancer navigation program at a tertiary Tanzanian academic hospital.” E Posters, BMJ Publishing Group Ltd, 2021. Crossref, doi:10.1136/ijgc-2021-igcs.157.
URI
https://scholars.duke.edu/individual/pub1515875
Source
crossref
Published In
E Posters
Published Date
DOI
10.1136/ijgc-2021-igcs.157

Abstract 102: Breakpoints in Protocol Compliance and Their Influence on Outcomes for Children with Wilms Tumor in Northern Tanzania

<jats:title>Abstract</jats:title> <jats:p>Purpose: Standardized treatment protocols for Wilms tumor have been developed for use in low- and middle-income countries (LMICs), but equivalent outcomes as high-income countries are not achieved outside of clinical trials. To identify critical breakpoints in protocol adherence contributing to reduced outcomes, we evaluated treatment compliance and impact of the completion of each stage of therapy on outcomes for Wilms tumor patients at a regional cancer referral hospital in northern Tanzania.</jats:p> <jats:p>Methods: This is a retrospective single-center cohort study for children diagnosed with Wilms tumor from 2016-2019 in Tanzania, treated per the International Society of Pediatric Oncology (SIOP) Africa adapted (2016-17) or standard (2018-19) therapy protocols. Treatment compliance was evaluated for both timing of chemotherapy initiation, and completion of risk-adapted therapy duration per protocol.</jats:p> <jats:p>Results: A total of 72 patients were evaluated. The two-year overall survival and event-free survival rates were 44% and 27%, respectively. Only 22% of patients completed recommended chemotherapy per protocol. There were delays at each stage of treatment, especially time to surgery (74 days), pathology report (32 days), and initiation of postoperative chemotherapy (39 days). A total of 38% of patients abandoned care, with 44% of abandonment occurring prior to surgery, 30% immediately after surgery, and 26% during post-operative chemotherapy. Compliance with surgical resection (p=0.05) and postoperative chemotherapy (p=0.04) were predictive of two-year overall survival.</jats:p> <jats:p>Conclusion: Standardized Wilms tumor treatment protocol compliance outside of clinical trials is low in many LMICs. In the current study, noncompliance with recommended chemotherapy correlated to reduced overall survival rates, with several identified key health system delays contributing to poor compliance. Future interventions targeting health system delays are critical to improve protocol compliance, increasing overall survival for pediatric Wilms tumor patients in LMICs.</jats:p> <jats:p>Citation Format: Austin Wesevich, Mocha George, Frank Kiwara, Colin Chao, Idd Shabani, John Igenge, Kristin Schroeder. Breakpoints in Protocol Compliance and Their Influence on Outcomes for Children with Wilms Tumor in Northern Tanzania [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 102.</jats:p>
Authors
Wesevich, A; George, M; Kiwara, F; Chao, C; Shabani, I; Igenge, J; Schroeder, K
MLA Citation
Wesevich, Austin, et al. “Abstract 102: Breakpoints in Protocol Compliance and Their Influence on Outcomes for Children with Wilms Tumor in Northern Tanzania.” Cancer Epidemiology, Biomarkers &Amp; Prevention, vol. 30, no. 7_Supplement, American Association for Cancer Research (AACR), 2021, pp. 102–102. Crossref, doi:10.1158/1538-7755.asgcr21-102.
URI
https://scholars.duke.edu/individual/pub1494769
Source
crossref
Published In
Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
Volume
30
Published Date
Start Page
102
End Page
102
DOI
10.1158/1538-7755.asgcr21-102

Abstract 112: Use of WhatsApp to Improve Medical Provider Communication for Children with Wilms Tumor in Tanzania

<jats:title>Abstract</jats:title> <jats:p>Purpose: Due to the rapid expansion of mobile phone usage throughout the world, mobile health (mHealth) technologies offer an innovative strategy to overcome challenges of care coordination and limited communication between pediatric cancer providers in LMICs. Our objective was to evaluate the use of the social media application WhatsApp to improve provider communication and outcomes for children diagnosed with Wilms tumor at a regional cancer treatment facility in Tanzania.</jats:p> <jats:p>Methods: A WhatsApp provider group was established in 2016 to facilitate communication between surgical, medical and psychosocial support providers at the regional cancer referral hospital in northern Tanzania. All messages exchanged from 2016-2019 were extracted and coded for thematic content. Treatment compliance and process outcomes were compared for patients discussed versus those that were not over the 4-year period.</jats:p> <jats:p>Results: A total of 669 messages for 55 patients were reviewed. Most messages were sent by the pediatric oncologist (44.8%, n=273) and urology resident (43.2%, n=263). Using the application to coordinate patient care reduced time to surgery from 90 days [IQR 65-109] to 60 days [IQR 47-80], and time to post-operative chemotherapy initiation from 46 days [IQR 39-55] to 19 days [IQR 16-30]. Rate of treatment abandonment was decreased for patients discussed in the chat group (26.7%) compared to those not discussed (38.2%).</jats:p> <jats:p>Conclusion: To our knowledge this is the first study to assess the use of WhatsApp to improve provider communication for children with cancer in LMICs. As access to smartphone technology and internet access improves, applications like WhatsApp can be used as a low-cost strategy to target health system inefficiencies and improve outcomes for children with cancer globally.</jats:p> <jats:p>Citation Format: John Igenge, Jacob Stocks, Gloria Zhang, Mocha George, Frank Kiwara, Judy Mafwimbo, Mastidia Maxmilian, Austin Wesevich, Kristin Schroeder. Use of WhatsApp to Improve Medical Provider Communication for Children with Wilms Tumor in Tanzania [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 112.</jats:p>
Authors
Igenge, J; Stocks, J; Zhang, G; George, M; Kiwara, F; Mafwimbo, J; Maxmilian, M; Wesevich, A; Schroeder, K
MLA Citation
Igenge, John, et al. “Abstract 112: Use of WhatsApp to Improve Medical Provider Communication for Children with Wilms Tumor in Tanzania.” Cancer Epidemiology, Biomarkers &Amp; Prevention, vol. 30, no. 7_Supplement, American Association for Cancer Research (AACR), 2021, pp. 112–112. Crossref, doi:10.1158/1538-7755.asgcr21-112.
URI
https://scholars.duke.edu/individual/pub1494770
Source
crossref
Published In
Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
Volume
30
Published Date
Start Page
112
End Page
112
DOI
10.1158/1538-7755.asgcr21-112

Abstract 101: The Tanzanian Pediatric Cancer Network: A Comprehensive Evaluation of the Incidence of Presenting Patients and Access to Pediatric Cancer Care in Tanzania

<jats:title>Abstract</jats:title> <jats:p>Purpose: In sub-Saharan Africa, cancer treatment facilities are often scarce and centered in urban areas, which means many patients must travel long distances to reach cancer care. Still, little is known about how this distribution of cancer centers impacts patients' ability to access care.</jats:p> <jats:p>Methods: Records of all pediatric patients (&amp;lt;18yo) treated for cancer in Tanzania in 2019 through the Tanzanian Pediatric Cancer Network were reviewed. This network represents all 9 hospitals currently treating children with cancer in Tanzania. Demographic and diagnostic information was recorded. ArcGIS was used to estimate patients' travel times from home addresses to cancer care. AccessMod was used to calculate 4-hour access for the population.</jats:p> <jats:p>Results: In 2019, a total of 821 pediatric patients were diagnosed with cancer with an incidence of 1.42/100,000 population. The most common diagnoses were Wilms tumor (17.2%, n=134), retinoblastoma (16.8%, n=131), and acute lymphoblastic leukemia (15.9%, n=124). There was regional variation by diagnosis, with the Lake Zone having the highest incidence of Burkitt lymphoma (0.29; average 0.15) and retinoblastoma (0.5; average 0.33). Reported regional incidence inversely correlated to distance to cancer treatment facility. Median travel time to cancer care for patients was 4.55 hours. Currently 74.5% of the population lives within 4 hours of existing cancer care facilities, and it would require adding cancer care capacity to 8 additional facilities to reach 95% coverage.</jats:p> <jats:p>Conclusions: This is the first comprehensive evaluation of the incidence of presenting pediatric cancer patients in Tanzania. Only 18.8% of the estimated pediatric patients with cancer in Tanzania were treated in 2019. The reported incidence was lower in areas further away from treatment centers, suggesting the importance of increased access to cancer care facilities as part of a future national scale-up strategy.</jats:p> <jats:p>Citation Format: Luke Maillie, Alice Mutagonda, Lulu Chirande, Laiti Rehema, Shakilu Jumanne, Elton Meleki, Furaha Serventi, Julius Alloyce, Franco Afyusisye, Sebastian Sanchez, Matthew Sisk, Marie Jose Voeten, Ester Kawira, Heronima Joas, Trish Scanlan, Kristin Schroeder. The Tanzanian Pediatric Cancer Network: A Comprehensive Evaluation of the Incidence of Presenting Patients and Access to Pediatric Cancer Care in Tanzania [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 101.</jats:p>
Authors
Maillie, L; Mutagonda, A; Chirande, L; Rehema, L; Jumanne, S; Meleki, E; Serventi, F; Alloyce, J; Afyusisye, F; Sanchez, S; Sisk, M; Voeten, MJ; Kawira, E; Joas, H; Scanlan, T; Schroeder, K
MLA Citation
Maillie, Luke, et al. “Abstract 101: The Tanzanian Pediatric Cancer Network: A Comprehensive Evaluation of the Incidence of Presenting Patients and Access to Pediatric Cancer Care in Tanzania.” Cancer Epidemiology, Biomarkers &Amp; Prevention, vol. 30, no. 7_Supplement, American Association for Cancer Research (AACR), 2021, pp. 101–101. Crossref, doi:10.1158/1538-7755.asgcr21-101.
URI
https://scholars.duke.edu/individual/pub1494783
Source
crossref
Published In
Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
Volume
30
Published Date
Start Page
101
End Page
101
DOI
10.1158/1538-7755.asgcr21-101

Abstract 4: Impact of Immunohistochemistry on Diagnostic Accuracy for Pediatric Cancer in Tanzania

<jats:title>Abstract</jats:title> <jats:p>Purpose: The current study evaluates the impact of immunohistochemistry (IHC) on diagnostic accuracy for pediatric cancer in Tanzania, and identifies the most common biomarkers used for diagnostic differentiation in our setting.</jats:p> <jats:p>Methods: Pathology samples for children diagnosed with cancer at Bugando Medical Centre (Mwanza, Tanzania) in 2018 were evaluated using H&amp;E staining. Basic demographic information from histology form was recorded, including patient age, sex, and sample collection, as well as the reported histopathology results from BMC. Additional tissue from histology block was sent to Muhimbili National Hospital for IHC review. The histopathology results were compared for diagnostic agreement, change in diagnosis, and identified which biomarkers were necessary for diagnostic confirmation.</jats:p> <jats:p>Results: One hundred and five (105) pediatric cancer patients were reviewed. 58 (55.2%) were female median age of 6 years (IQR 3-9 years). Most common pediatric diagnoses were Burkitt lymphoma and Non Hodgkin Lymphoma specifically Diffuse Large B-cell lymphoma, anaplastic large cell lymphoma, FL, LL. Overall histology concordance between H&amp;E and IHC was 51.0%. Most common discordant diagnosis was NHL of ALCL (ALK1-negative, CD-45, 30-positivity). Most concordant was Leukemia (BCR-ABL). Diagnostic specificity (example: in Non-Hodgkin Lymphoma) improved for 17.6% (n=18). The most common diagnosis with increased specificity was DLBCL. Among NHL, 39% (n=7) were ALCL, 27% (n=5) DLBCL, 17% (n=3) Lymphoblastic Lymphoma, 17% (n=3) Follicular lymphoma. The use of immunohistochemistry resulted in a change in diagnosis for 31.4% (n=32) of patient. The most common changed diagnosis was Burkitt Lymphoma and Sarcoma.</jats:p> <jats:p>Conclusion: Immunohistochemistry is critically important for accurate diagnosis of pediatric cancer, with over 30% of all cases identified as having treatment changing diagnoses. IHC training is critical and a limited common biomarker panel can successfully be used in low resource countries to improve treatment selection.</jats:p> <jats:p>Citation Format: Jeffer Bhuko, Caroline Minja, Michael McDermott, Maureen Osullivan, Trish Scanlan, Kristin Schroeder. Impact of Immunohistochemistry on Diagnostic Accuracy for Pediatric Cancer in Tanzania [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 4.</jats:p>
Authors
Bhuko, J; Minja, C; McDermott, M; Osullivan, M; Scanlan, T; Schroeder, K
MLA Citation
Bhuko, Jeffer, et al. “Abstract 4: Impact of Immunohistochemistry on Diagnostic Accuracy for Pediatric Cancer in Tanzania.” Cancer Epidemiology, Biomarkers &Amp; Prevention, vol. 30, no. 7_Supplement, American Association for Cancer Research (AACR), 2021, pp. 4–4. Crossref, doi:10.1158/1538-7755.asgcr21-4.
URI
https://scholars.duke.edu/individual/pub1494784
Source
crossref
Published In
Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology
Volume
30
Published Date
Start Page
4
End Page
4
DOI
10.1158/1538-7755.asgcr21-4

Research Areas:

Global Oncology
Pediatric Neuro-oncology
Pediatrics