Bayesian approach for flexible modeling of semicompeting risks data

Stat Med. 2014 Dec 20;33(29):5111-25. doi: 10.1002/sim.6313. Epub 2014 Oct 2.


Semicompeting risks data arise when two types of events, non-terminal and terminal, are observed. When the terminal event occurs first, it censors the non-terminal event, but not vice versa. To account for possible dependent censoring of the non-terminal event by the terminal event and to improve prediction of the terminal event using the non-terminal event information, it is crucial to model their association properly. Motivated by a breast cancer clinical trial data analysis, we extend the well-known illness-death models to allow flexible random effects to capture heterogeneous association structures in the data. Our extension also represents a generalization of the popular shared frailty models that usually assume that the non-terminal event does not affect the hazards of the terminal event beyond a frailty term. We propose a unified Bayesian modeling approach that can utilize existing software packages for both model fitting and individual-specific event prediction. The approach is demonstrated via both simulation studies and a breast cancer data set analysis.

Keywords: Markov chain Monte Carlo; illness-death; random effects; semicompeting risks.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Antineoplastic Agents, Hormonal / administration & dosage
  • Antineoplastic Agents, Hormonal / pharmacology
  • Bayes Theorem
  • Breast Neoplasms / drug therapy
  • Breast Neoplasms / mortality*
  • Breast Neoplasms / pathology
  • Clinical Trials as Topic / methods
  • Clinical Trials as Topic / statistics & numerical data*
  • Computer Simulation
  • Disease Progression*
  • Female
  • Humans
  • Likelihood Functions
  • Markov Chains
  • Monte Carlo Method
  • Neoplasm Metastasis
  • Prognosis
  • Proportional Hazards Models
  • Regression Analysis
  • Risk Assessment / methods
  • Risk Assessment / statistics & numerical data
  • Survival Analysis
  • Tamoxifen / administration & dosage
  • Tamoxifen / pharmacology
  • Time Factors


  • Antineoplastic Agents, Hormonal
  • Tamoxifen