title: Multi-state models for colon cancer recurrence and death with a cured fraction.
abstract: In cancer clinical trials, patients often experience a recurrence of disease prior to the outcome of interest, overall survival. Additionally, for many cancers, there is a cured fraction of the population who will never experience a recurrence. There is often interest in how different covariates affect the probability of being cured of disease and the time to recurrence, time to death, and time to death after recurrence. We propose a multi-state Markov model with an incorporated cured fraction to jointly model recurrence and death in colon cancer. A Bayesian estimation strategy is used to obtain parameter estimates. The model can be used to assess how individual covariates affect the probability of being cured and each of the transition rates. Checks for the adequacy of the model fit and for the functional forms of covariates are explored. The methods are applied to data from 12 randomized trials in colon cancer, where we show common effects of specific covariates across the trials.
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI, U.S.A.
authors.forename: A S C
authors.initials: AS
authors.lastname: Conlon
authors.forename: J M G
authors.initials: JM
authors.lastname: Taylor
authors.forename: D J
authors.initials: DJ
authors.lastname: Sargent
mesh_terms: D001499:Bayes Theorem; D017326:Clinical Trials, Phase III as Topic / Q000379:methods*; D003110:Colonic Neoplasms / Q000401:mortality / Q000628:therapy; D003198:Computer Simulation; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D015233:Models, Statistical; D009364:Neoplasm Recurrence, Local
keywords: Cox-Snell residuals; colon cancer; cure model; deviance residuals; multi-state model