title: A flexible parametric approach to examining spatial variation in relative survival.
abstract: Most of the few published models used to obtain small-area estimates of relative survival are based on a generalized linear model with piecewise constant hazards under a Bayesian formulation. Limitations of these models include the need to artificially split the time scale, restricted ability to include continuous covariates, and limited predictive capacity. Here, an alternative Bayesian approach is proposed: a spatial flexible parametric relative survival model. This overcomes previous limitations by combining the benefits of flexible parametric models: the smooth, well-fitting baseline hazard functions and predictive ability, with the Bayesian benefits of robust and reliable small-area estimates. Both spatially structured and unstructured frailty components are included. Spatial smoothing is conducted using the intrinsic conditional autoregressive prior. The model was applied to breast, colorectal, and lung cancer data from the Queensland Cancer Registry across 478 geographical areas. Advantages of this approach include the ease of including more realistic complexity, the feasibility of using individual-level input data, and the capacity to conduct overall, cause-specific, and relative survival analysis within the same framework. Spatial flexible parametric survival models have great potential for exploring small-area survival inequalities, and we hope to stimulate further use of these models within wider contexts. Copyright © 2016 John Wiley & Sons, Ltd.
authors: Cancer Council Queensland, Brisbane, Australia.|ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology (QUT), Brisbane, Australia.
authors: Susanna M
authors: 0000-0001-9041-9531
authors: SM
authors: Cramb
authors: ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology (QUT), Brisbane, Australia.|Cooperative Research Centre for Spatial Information, Melbourne, Australia.
authors: Kerrie L
authors: KL
authors: Mengersen
authors: Department of Health Sciences, University of Leicester, Leicester, U.K.
authors: Paul C
authors: PC
authors: Lambert
authors: ARC Centre of Excellence for Mathematical and Statistical Frontiers, University of Technology, Sydney, Australia.
authors: Louise M
authors: LM
authors: Ryan
authors: Cancer Council Queensland, Brisbane, Australia.|School of Mathematical Sciences, Queensland University of Technology (QUT), Brisbane, Australia.|Menzies School of Health Research, Brisbane, Australia.
authors: Peter D
authors: PD
authors: Baade
mesh_terms: D001499:Bayes Theorem; D006801:Humans; D016014:Linear Models; D009369:Neoplasms / Q000401:mortality*; D011793:Queensland; D012042:Registries; D016019:Survival Analysis
keywords: Australia; Bayesian; cancer; flexible parametric; relative survival; small area