Semiparametric Bayesian approaches to joinpoint regression for population-based cancer survival data

Abstract

According to the American Cancer Society report (1999), cancer surpasses heart disease as the leading cause of death in the United States of America (USA) for people of age less than 85. Thus, medical research in cancer is an important public health interest. Understanding how medical improvements are affecting cancer incidence, mortality and survival is critical for effective cancer control. In this paper, we study the cancer survival trend on the population level cancer data. In particular, we develop a parametric Bayesian joinpoint regression model based on a Poisson distribution for the relative survival. To avoid identifying the cause of death, we only conduct analysis based on the relative survival. The method is further extended to the semiparametric Bayesian joinpoint regression models wherein the parametric distributional assumptions of the joinpoint regression models are relaxed by modeling the distribution of regression slopes using Dirichlet process mixtures. We also consider the effect of adding covariates of interest in the joinpoint model. Three model selection criteria, namely, the conditional predictive ordinate (CPO), the expected predictive deviance (EPD), and the deviance information criteria (DIC), are used to select the number of joinpoints. We analyze the grouped survival data for distant testicular cancer from the Surveillance, Epidemiology, and End Results (SEER) Program using these Bayesian models.