Estimating and comparing cancer progression risks under varying surveillance protocols

Jane M. Lange, Roman Gulati, Amy S. Leonardson, Daniel W. Lin, Lisa F. Newcomb, Bruce J. Trock, H. Ballentine Carter, Peter R. Carroll, Matthew R. Cooperberg, Janet E. Cowan, Lawrence H. Klotz, Ruth Etzioni

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Outcomes after cancer diagnosis and treatment are often observed at discrete times via doctor-patient encounters or specialized diagnostic examinations. Despite their ubiquity as endpoints in cancer studies, such outcomes pose challenges for analysis. In particular, comparisons between studies or patient populations with different surveillance schema may be confounded by differences in visit frequencies. We present a statistical framework based on multistate and hidden Markov models that represents events on a continuous time scale given data with discrete observation times. To demonstrate this framework, we consider the problem of comparing risks of prostate cancer progression across multiple active surveillance cohorts with different surveillance frequencies. We show that the different surveillance schedules partially explain observed differences in the progression risks between cohorts. Our application permits the conclusion that differences in underlying cancer progression risks across cohorts persist after accounting for different surveillance frequencies.

Original languageEnglish (US)
Pages (from-to)1773-1795
Number of pages23
JournalAnnals of Applied Statistics
Issue number3
StatePublished - Sep 2018
Externally publishedYes


  • Active surveillance
  • Hidden Markov model
  • Multistate model
  • Panel data
  • Prostate cancer

ASJC Scopus subject areas

  • Statistics and Probability
  • Modeling and Simulation
  • Statistics, Probability and Uncertainty


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