A review on competing risks methods for survival analysis

When modelling competing risks survival data, several techniques have been proposed in both the statistical and machine learning literature. State-of-the-art methods have extended classical approaches with more flexible assumptions that can improve predictive performance, allow high dimensional data and missing values, among others. Despite this, modern approaches have not been widely employed in applied settings. This article aims to aid the uptake of such methods by providing a condensed compendium of competing risks survival methods with a unified notation and interpretation across approaches. We highlight available software and, when possible, demonstrate their usage via reproducible R vignettes. Moreover, we discuss two major concerns that can affect benchmark studies in this context: the choice of performance metrics and reproducibility.Comment: 22 pages, 2 table

Hierarchical models for semi-competing risks data with application to quality of end-of-life care for pancreatic cancer

Readmission following discharge from an initial hospitalization is a key marker of quality of health care in the United States. For the most part, readmission has been used to study quality of care for patients with acute health conditions, such as pneumonia and heart failure, with analyses typically based on a logistic-Normal generalized linear mixed model. Applying this model to the study readmission among patients with increasingly prevalent advanced health conditions such as pancreatic cancer is problematic, however, because it ignores death as a competing risk. A more appropriate analysis is to imbed such studies within the semi-competing risks framework. To our knowledge, however, no comprehensive statistical methods have been developed for cluster-correlated semi-competing risks data. In this paper we propose a novel hierarchical modeling framework for the analysis of cluster-correlated semi-competing risks data. The framework permits parametric or non-parametric specifications for a range of model components, including baseline hazard functions and distributions for key random effects, giving analysts substantial flexibility as they consider their own analyses. Estimation and inference is performed within the Bayesian paradigm since it facilitates the straightforward characterization of (posterior) uncertainty for all model parameters including hospital-specific random effects. The proposed framework is used to study the risk of readmission among 5,298 Medicare beneficiaries diagnosed with pancreatic cancer at 112 hospitals in the six New England states between 2000-2009, specifically to investigate the role of patient-level risk factors and to characterize variation in risk across hospitals that is not explained by differences in patient case-mix

The Bernstein-Von Mises Theorem in Semiparametric Competing Risks Models

Semiparametric Bayesian models are nowadays a popular tool in survival analysis. An important area of research concerns the investigation of frequentist properties of these models. In this paper, a Bernstein-von Mises theorem is derived for semiparametric Bayesian models of competing risks data. The cause-specific hazard is taken as the product of the conditional probability of a failure type and the overall hazard rate. We model the conditional probability as a smooth function of time and leave the cumulative overall hazard unspecified. A prior distribution is defined on the joint parameter space, which includes a beta process prior for the cumulative overall hazard. We show that the posterior distribution for any differentiable functional of interest is asymptotically equivalent to the sampling distribution derived from maximum likelihood estimation. A simulation study is provided to illustrate the coverage properties of credible intervals on cumulative incidence functions.Bayesian nonparametrics, Bernstein-von Mises theorem, beta process, competing risks, conditional probability of a failure type, semiparametric inference.