Background Royston-Parmar flexible parametric survival models (FPMs) can be fitted on either the cause-specific hazards or cumulative incidence scale in the presence of competing risks. An advantage of modelling within this framework for competing risks data is the ease at which alternative predictions to the (cause-specific or subdistribution) hazard ratio can be obtained. Restricted mean survival time (RMST) is one such measure. This has an attractive interpretation, especially when the proportionality assumption is violated. Compared to similar measures, fewer assumptions are required and it does not require extrapolation. Furthermore, one can easily obtain the expected number of life-years lost, or gained, due to a particular cause of death, which is a further useful prognostic measure as introduced by Andersen.
Methods We present various measures, including the expected life-years lost due to a cause of death, which can be predicted for a specific covariate pattern to facilitate interpretation in observational studies. Summaries are also provided at the population-level using standardisation to obtain marginal measures. RMST is obtained in the presence of competing risks using Royston-Parmar FPMs. Predictions are illustrated using English colorectal data and are obtained using the Stata post-estimation command, standsurv.
Results Reporting such measures facilitate interpretation of a competing risks analysis, particularly when the proportional hazards assumption is not appropriate. Standardisation provides a useful way to obtain marginal estimates to make absolute comparisons between two covariate groups. Predictions can be made at various time-points and presented visually for each cause of death to better understand the overall impact of different covariate groups.
Conclusions We describe estimation of RMST and expected life-years lost, both partitioned by each competing cause of death after fitting a single FPM on either the log-cumulative subdistribution, or cause-specific hazards scale. These can be used to facilitate interpretation of a competing risks analysis when the proportionality assumption is in doubt.