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:

Parental limited English proficiency in pediatric stem cell transplantation: Clinical impact and health care utilization.

BACKGROUND: Limited English proficiency (LEP) is associated with adverse clinical outcomes. The clinical impact of LEP in hematopoietic stem cell transplant (HSCT) has not been studied. The objectives of this study were to compare HSCT outcomes and health care utilization of Hispanic pediatric patients with and without parental LEP. METHODS: We conducted a retrospective review of Hispanic/Latino pediatric patients receiving HSCT at a single institution. Families were identified as LEP or English proficient (EP) based on clinicians' notes, social work documentation, or the signature of a Spanish interpreter on treatment consents. RESULTS: A total of 83 Hispanic/Latino patients were identified with 53 (65.1%) having parental LEP. More patients in the LEP group had a documented financial burden at pretransplant psychosocial evaluation (72.2% vs. 41.4%, p = .009). LEP patients were more likely to have health insurance coverage through government-sponsored Medicaid (76.9% vs. 27.6%, p < .001). LEP patients were hospitalized on average 13 days longer than EP patients, and LEP patients were more likely to have pretransplant cytomegalovirus (CMV) reactivity (67.3%) than EP patients (p = .001). Overall survival was lower in LEP than EP, but was not statistically significant (p = .193). Multivariable Cox modeling suggested a potentially higher risk of death in LEP versus EP (hazard ratio = 1.56, 95% CI: 0.38, 6.23). CONCLUSIONS: Parental LEP in HSCT is associated with prolonged hospitalization and pretransplant CMV reactivity. These factors are associated with posttransplant complications and death. Our results suggest parental LEP is a risk factor for poor HSCT outcomes. Further study is warranted in a larger cohort.
MLA Citation
Robles, Joanna M., et al. “Parental limited English proficiency in pediatric stem cell transplantation: Clinical impact and health care utilization.Pediatr Blood Cancer, vol. 68, no. 9, Sept. 2021, p. e29174. Pubmed, doi:10.1002/pbc.29174.
URI
https://scholars.duke.edu/individual/pub1484724
PMID
34109732
Source
pubmed
Published In
Pediatr Blood Cancer
Volume
68
Published Date
Start Page
e29174
DOI
10.1002/pbc.29174

Caregiver acceptability of mobile phone use for pediatric cancer care in Tanzania: Cross-Sectional Questionnaire Study (Preprint)

Authors
Schroeder, K; Maiarana, J; Gisiri, M; Joo, E; Muiruri, C; Zullig, L; Masalu, N; Vasudevan, L
MLA Citation
Schroeder, Kristin, et al. “Caregiver acceptability of mobile phone use for pediatric cancer care in Tanzania: Cross-Sectional Questionnaire Study (Preprint).” Jmir Pediatrics and Parenting, JMIR Publications Inc. Crossref, doi:10.2196/27988.
URI
https://scholars.duke.edu/individual/pub1481957
Source
crossref
Published In
Jmir Pediatr Parent
DOI
10.2196/27988

Clinical Outcomes and Patient-Matched Molecular Composition of Relapsed Medulloblastoma.

PURPOSE: We sought to investigate clinical outcomes of relapsed medulloblastoma and to compare molecular features between patient-matched diagnostic and relapsed tumors. METHODS: Children and infants enrolled on either SJMB03 (NCT00085202) or SJYC07 (NCT00602667) trials who experienced medulloblastoma relapse were analyzed for clinical outcomes, including anatomic and temporal patterns of relapse and postrelapse survival. A largely independent, paired molecular cohort was analyzed by DNA methylation array and next-generation sequencing. RESULTS: A total of 72 of 329 (22%) SJMB03 and 52 of 79 (66%) SJYC07 patients experienced relapse with significant representation of Group 3 and wingless tumors. Although most patients exhibited some distal disease (79%), 38% of patients with sonic hedgehog tumors experienced isolated local relapse. Time to relapse and postrelapse survival varied by molecular subgroup with longer latencies for patients with Group 4 tumors. Postrelapse radiation therapy among previously nonirradiated SJYC07 patients was associated with long-term survival. Reirradiation was only temporizing for SJMB03 patients. Among 127 patients with patient-matched tumor pairs, 9 (7%) experienced subsequent nonmedulloblastoma CNS malignancies. Subgroup (96%) and subtype (80%) stabilities were largely maintained among the remainder. Rare subgroup divergence was observed from Group 4 to Group 3 tumors, which is coincident with genetic alterations involving MYC, MYCN, and FBXW7. Subgroup-specific patterns of alteration were identified for driver genes and chromosome arms. CONCLUSION: Clinical behavior of relapsed medulloblastoma must be contextualized in terms of up-front therapies and molecular classifications. Group 4 tumors exhibit slower biological progression. Utility of radiation at relapse is dependent on patient age and prior treatments. Degree and patterns of molecular conservation at relapse vary by subgroup. Relapse tissue enables verification of molecular targets and identification of occult secondary malignancies.
Authors
Kumar, R; Smith, KS; Deng, M; Terhune, C; Robinson, GW; Orr, BA; Liu, APY; Lin, T; Billups, CA; Chintagumpala, M; Bowers, DC; Hassall, TE; Hansford, JR; Khuong-Quang, DA; Crawford, JR; Bendel, AE; Gururangan, S; Schroeder, K; Bouffet, E; Bartels, U; Fisher, MJ; Cohn, R; Partap, S; Kellie, SJ; McCowage, G; Paulino, AC; Rutkowski, S; Fleischhack, G; Dhall, G; Klesse, LJ; Leary, S; Nazarian, J; Kool, M; Wesseling, P; Ryzhova, M; Zheludkova, O; Golanov, AV; McLendon, RE; Packer, RJ; Dunham, C; Hukin, J; Fouladi, M; Faria, CC; Pimentel, J; Walter, AW; Jabado, N; Cho, Y-J; Perreault, S; Croul, SE; Zapotocky, M; Hawkins, C; Tabori, U; Taylor, MD; Pfister, SM; Klimo, P; Boop, FA; Ellison, DW; Merchant, TE; Onar-Thomas, A; Korshunov, A; Jones, DTW; Gajjar, A; Ramaswamy, V; Northcott, PA
MLA Citation
Kumar, Rahul, et al. “Clinical Outcomes and Patient-Matched Molecular Composition of Relapsed Medulloblastoma.J Clin Oncol, vol. 39, no. 7, Mar. 2021, pp. 807–21. Pubmed, doi:10.1200/JCO.20.01359.
URI
https://scholars.duke.edu/individual/pub1472610
PMID
33502920
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
39
Published Date
Start Page
807
End Page
821
DOI
10.1200/JCO.20.01359

Integration of cancer registry and electronic health record data to construct a childhood cancer survivorship cohort, facilitate risk stratification for late effects, and assess appropriate follow-up care.

BACKGROUND: This retrospective study harnessed an institutional cancer registry to construct a childhood cancer survivorship cohort, integrate electronic health record (EHR) and geospatial data to stratify survivors based on late-effect risk, analyze follow-up care patterns, and determine factors associated with suboptimal follow-up care. PROCEDURE: The survivorship cohort included patients ≤18 years of age reported to the institutional cancer registry between January 1, 1994 and November 30, 2012. International Classification of Diseases for Oncology, third revision (ICD-O-3) coding and treatment exposures facilitated risk stratification of survivors. The EHR was linked to the cancer registry based on medical record number (MRN) to extract clinic visits. RESULTS: Five hundred and ninety pediatric hematology-oncology (PHO) and 275 pediatric neuro-oncology (PNO) survivors were included in the final analytic cohort. Two hundred and eight-two survivors (32.6%) were not seen in any oncology-related subspecialty clinic at Duke 5-7 years after initial diagnosis. Factors associated with follow-up included age (p = .008), diagnosis (p < .001), race/ethnicity (p = .010), late-effect risk strata (p = .001), distance to treatment center (p < .0001), and area deprivation index (ADI) (p = .011). Multivariable logistic modeling attenuated the association for high-risk (OR 1.72; 95% CI 0.805, 3.66) and intermediate-risk (OR 1.23, 95% CI 0.644, 2.36) survivors compared to survivors at low risk of late effects among the PHO cohort. PNO survivors at high risk for late effects were more likely to follow up (adjusted OR 3.66; 95% CI 1.76, 7.61). CONCLUSIONS: Nearly a third of survivors received suboptimal follow-up care. This study provides a reproducible model to integrate cancer registry and EHR data to construct risk-stratified survivorship cohorts to assess follow-up care.
Authors
Noyd, DH; Neely, NB; Schroeder, KM; Lantos, PM; Power, S; Kreissman, SG; Oeffinger, KC
URI
https://scholars.duke.edu/individual/pub1476847
PMID
33742534
Source
pubmed
Published In
Pediatr Blood Cancer
Volume
68
Published Date
Start Page
e29014
DOI
10.1002/pbc.29014

Impact of Capacity Development Program on Outcomes for Pediatric Hematologic Malignancies in Tanzania

<jats:p>Background:</jats:p> <jats:p>Globally, over 400,000 children are diagnosed with cancer each year, with hematologic malignancies being the most common diagnosis. However, there is a 60% survival gap between high income and low to middle income countries. Causes of this disparity are multifactorial and require comprehensive capacity development to improve outcomes. In 2014, a twinning program was started between Duke University and Bugando Medical Centre (BMC) in Mwanza Tanzania, focused on the development of treatment capacity for pediatric hematologic malignancies. We report on the program development and impact on outcomes for leukemia.</jats:p> <jats:p>Methods:</jats:p> <jats:p>Key stakeholder interviews were completed at BMC to identify areas for capacity development. A Duke University pediatric hematology/oncology faculty member spends 6 months per year on site to provide training and clinical care. Capacity development was completed through a step-wise approach based on identified needs, with one new area of focus per year. Outcome evaluation includes 1-year overall survival by diagnosis and year.</jats:p> <jats:p>Results:</jats:p> <jats:p>Stakeholder identified needs included development of a patient registry for monitoring, reducing cost of care, and improving provider knowledge about pediatric cancer. In 2014 the partnership established a cancer registry for outcome monitoring, and provided medical and laboratory training on the resource adapted diagnostic and treatment protocols for hematologic malignancies. In 2015, partnerships with local non-profit organizations provided chemotherapy and diagnostic testing at no cost to the patients. In 2016, the focus was on providing social support through the use of a patient navigation program and provision of local housing during treatment; in 2017 formalized treatment collaboration between BMC and the Tanzanian National Pediatric Hospital (MNH) was established. Additional local non-governmental support allowed for the transfer of patients between hospitals and care coordination.</jats:p> <jats:p>New pediatric cancer diagnoses at BMC increased from 100 in 2014 to 170 in 2018. From 2014-2018, leukemia represented 5-17 % of total cases, and lymphomas 20-30%. 1-year overall survival for ALL was 0% prior to 2016, and an average of 56% for 2016-2018. AML 1-yr OS remained 0% over the 5-year period. CML 1-yr OS increased from 0% in 2014-2015 to 25% in 2016-2018.</jats:p> <jats:p>From 2017-2018, 38% of patients diagnosed at BMC received national care coordination with 13% of these patients receiving part of their treatment plan at MNH.</jats:p> <jats:p>Discussion</jats:p> <jats:p>Despite increased training and reduced treatment costs, social support through patient navigation and a structured treatment collaboration were critical to improved outcomes for children with hematologic malignancies. These should be a priority for the development of future pediatric cancer programs in low resource settings. Additional focus on myeloid malignancies is needed to identify potential areas for outcome improvement.</jats:p> <jats:sec> <jats:title>Disclosures</jats:title> <jats:p>No relevant conflicts of interest to declare.</jats:p> </jats:sec>
Authors
Schroeder, K; Rizzieri, T; Robles, J; Sued, H; Scanlan, P; Mafwimbo, J; Maxmilian, M; Kamanga, J; Masalu, N; Chao, NJ
MLA Citation
Schroeder, Kristin, et al. “Impact of Capacity Development Program on Outcomes for Pediatric Hematologic Malignancies in Tanzania.” Blood, vol. 134, no. Supplement_1, American Society of Hematology, 2019, pp. 4744–4744. Crossref, doi:10.1182/blood-2019-131044.
URI
https://scholars.duke.edu/individual/pub1469647
Source
crossref
Published In
Blood
Volume
134
Published Date
Start Page
4744
End Page
4744
DOI
10.1182/blood-2019-131044

Research Areas:

Global Oncology
Pediatric Neuro-oncology
Pediatrics