Estimating and modeling the proportion cured of disease in population-based cancer studies

In population-based cancer studies, cure is said to occur when the mortality (hazard) rate in the diseased group of individuals returns to the same level as that expected in the general population. The cure fraction (the proportion of patients cured of disease) is of interest to patients and a useful measure to monitor trends in survival of curable disease. I will describe two types of cure model, namely, the mixture and nonmixture cure model (Sposto 2002); explain how they can be extended to incorporate the expected mortality rate (obtained from routine data sources); and discuss their implementation in Stata using the strsmix and strsnmix commands. In both commands there is the choice of parametric distribution (Weibull, generalized gamma, and log–logistic) and link function for the cure fraction (identity, logit, and log(–log)). As well as modeling the cure fraction it is possible to include covariates for the ancillary parameters for the parametric distributions. This ability is important, as it allows for departures from proportional excess hazards (typical in many population-based cancer studies). Both commands incorporate delayed entry and can therefore be used to obtain up-to-date estimates of the cure fraction by using period analysis (Smith et al. 2004). There is also an associated predict command that allows prediction of the cure fraction, relative survival, and the excess mortality rate with associated confidence intervals. For some cancers the parametric distributions listed above do not fit the data well, and I will describe how finite mixture distributions can be used to overcome this limitation. I will use examples from international cancer registries to illustrate the approach.

Flexible Parametric Survival Analysis Using Stata: Beyond the Cox Model

Michael Mitchell’s Data Management Using Stata comprehensively covers data-management tasks, from those a beginning statistician would need to those hard-to-verbalize tasks that can confound an experienced user. Mitchell does this all in simple language with illustrative examples.Stata, survival models, parametric models, Cox model

Estimating and modelling cure in population-based cancer studies within the framework of flexible parametric survival models

<p>Abstract</p> <p>Background</p> <p>When the mortality among a cancer patient group returns to the same level as in the general population, that is, the patients no longer experience excess mortality, the patients still alive are considered "statistically cured". Cure models can be used to estimate the cure proportion as well as the survival function of the "uncured". One limitation of parametric cure models is that the functional form of the survival of the "uncured" has to be specified. It can sometimes be hard to find a survival function flexible enough to fit the observed data, for example, when there is high excess hazard within a few months from diagnosis, which is common among older age groups. This has led to the exclusion of older age groups in population-based cancer studies using cure models.</p> <p>Methods</p> <p>Here we have extended the flexible parametric survival model to incorporate cure as a special case to estimate the cure proportion and the survival of the "uncured". Flexible parametric survival models use splines to model the underlying hazard function, and therefore no parametric distribution has to be specified.</p> <p>Results</p> <p>We have compared the fit from standard cure models to our flexible cure model, using data on colon cancer patients in Finland. This new method gives similar results to a standard cure model, when it is reliable, and better fit when the standard cure model gives biased estimates.</p> <p>Conclusions</p> <p>Cure models within the framework of flexible parametric models enables cure modelling when standard models give biased estimates. These flexible cure models enable inclusion of older age groups and can give stage-specific estimates, which is not always possible from parametric cure models.</p

A multi-state model incorporating estimation of excess hazards and multiple time scales

As cancer patient survival improves, late effects from treatment are becoming the next clinical challenge. Chemotherapy and radiotherapy, for example, potentially increase the risk of both morbidity and mortality from second malignancies and cardiovascular disease. To provide clinically relevant population-level measures of late effects, it is of importance to (1) simultaneously estimate the risks of both morbidity and mortality, (2) partition these risks into the component expected in the absence of cancer and the component due to the cancer and its treatment, and (3) incorporate the multiple time scales of attained age, calendar time, and time since diagnosis. Multi-state models provide a framework for simultaneously studying morbidity and mortality, but do not solve the problem of partitioning the risks. However, this partitioning can be achieved by applying a relative survival framework, by allowing is to directly quantify the excess risk. This paper proposes a combination of these two frameworks, providing one approach to address (1)-(3). Using recently developed methods in multi-state modeling, we incorporate estimation of excess hazards into a multi-state model. Both intermediate and absorbing state risks can be partitioned and different transitions are allowed to have different and/or multiple time scales. We illustrate our approach using data on Hodgkin lymphoma patients and excess risk of diseases of the circulatory system, and provide user-friendly Stata software with accompanying example code

Saliva Stimulants and the Oral Health of Geriatric Patients

Root-surface caries (RSC) has been recognized as a specific and important dental disease. Significant advances have been made in the pathology and microbiology of RSC, and the need to standardize the guidelines for recording RSC data has been recognized. Researchers have emphasized the increasing impact RSC will have on the geriatric population, especially since the methods to treat and prevent this disease are limited. The purpose of this study was to investigate the possibility of limiting RSC in a Veterans Administration (VA) patient population, using polyol-containing saliva stimulants that were voluntarily consumed by residents of a VA Medical Center (VAMC) over a period of from six to 30 months. Another aim was to study the effect of this program on the gingival health of periodontal patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68278/2/10.1177_08959374950090020901.pd

Characterization of the near-Earth Asteroid 2002NY40

In August 2002, the near-Earth asteroid 2002 NY40, made its closest approach to the Earth. This provided an opportunity to study a near-Earth asteroid with a variety of instruments. Several of the telescopes at the Maui Space Surveillance System were trained at the asteroid and collected adaptive optics images, photometry and spectroscopy. Analysis of the imagery reveals the asteroid is triangular shaped with significant self-shadowing. The photometry reveals a 20-hour period and the spectroscopy shows that the asteroid is a Q-type

Caustic Formation in Tachyon Effective Field Theories

Certain configurations of D-branes, for example wrong dimensional branes or the brane-antibrane system, are unstable to decay. This instability is described by the appearance of a tachyonic mode in the spectrum of open strings ending on the brane(s). The decay of these unstable systems is described by the rolling of the tachyon field from the unstable maximum to the minimum of its potential. We analytically study the dynamics of the inhomogeneous tachyon field as it rolls towards the true vacuum of the theory in the context of several different tachyon effective actions. We find that the vacuum dynamics of these theories is remarkably similar and in particular we show that in all cases the tachyon field forms caustics where second and higher derivatives of the field blow up. The formation of caustics signals a pathology in the evolution since each of the effective actions considered is not reliable in the vicinity of a caustic. We speculate that the formation of caustics is an artifact of truncating the tachyon action, which should contain all orders of derivatives acting on the field, to a finite number of derivatives. Finally, we consider inhomogeneous solutions in p-adic string theory, a toy model of the bosonic tachyon which contains derivatives of all orders acting on the field. For a large class of initial conditions we conclusively show that the evolution is well behaved in this case. It is unclear if these caustics are a genuine prediction of string theory or not.Comment: 23 pages, 5 figures; accepted for publication in JHEP. Revised derivation of eikonal equation for the DBI action. Added comments concerning the relationship between p-adic string theory and tachyon matter. Added second example of inhomogeneous evolution in p-adic string theory. Misleading statements concerning caustic-free evolution removed, references adde