A General Approach for Cure Models in Survival Analysis

Abstract

In survival analysis it often happens that some subjects under study do not experience the event of interest; they are considered to be `cured'. The population is thus a mixture of two subpopulations: the one of cured subjects, and the one of `susceptible' subjects. When covariates are present, a so-called mixture cure model can be used to model the conditional survival function of the population. It depends on two components: the probability of being cured and the conditional survival function of the susceptible subjects. In this paper we propose a novel approach to estimate a mixture cure model when the data are subject to random right censoring. We work with a parametric model for the cure proportion (like e.g. a logistic model), while the conditional survival function of the uncured subjects is unspecified. The approach is based on an inversion which allows to write the survival function as a function of the distribution of the observable random variables. This leads to a very general class of models, which allows a flexible and rich modeling of the conditional survival function. We show the identifiability of the proposed model, as well as the weak consistency and the asymptotic normality of the model parameters. We also consider in more detail the case where kernel estimators are used for the nonparametric part of the model. The new estimators are compared with the estimators from a Cox mixture cure model via finite sample simulations. Finally, we apply the new model and estimation procedure on two medical data sets.