Made available in DSpace on 2015-03-03T15:28:32Z (GMT). No. of bitstreams: 1 AlyssonLVG_DISSERT.pdf: 742336 bytes, checksum: 91f0c0ab60d1d0bf85017fb8994c46fe (MD5) Previous issue date: 2011-10-19 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / In this work we study the accelerated failure-time generalized Gamma regression models with a unified approach. The models attempt to estimate simultaneously the effects of covariates on the acceleration/deceleration of the timing of a given event and the surviving fraction. The method is implemented in the free statistical software R. Finally the model is applied to a real dataset referring to the time until the return of the disease in patients diagnosed with breast cancer / Neste trabalho apresentamos um estudo sobre o modelo de tempo de falha acelerado gama generalizado com fra??o de cura sob uma abordagem unificada. O modelo se prop?e a estimar simultaneamente o efeito de covari?veis na acelera??o/desacelera??o do tempo at? a ocorr?ncia de um evento e na fra??o de cura. O m?todo e implementado no software estat?stico livre R. Por fim o modelo e aplicado a dados reais referente ao tempo at? o retorno da doen?a em pacientes diagnosticados com c?ncer de mama

Abstract Monitoring regional variation in the survival of cancer patients is an important tool for assessing realisation of regional equity in cancer care. When regions are small or sparsely populated, the random component in the total variation across the regions becomes prominent. The broad aim of this doctoral thesis is to develop methods for assessing regional variation in the cause-specific and relative survival of cancer patients in a country and for quantifying the public health impact of the regional variation in the presence of competing hazards of death using summary measures that are interpretable also for policy-makers and other stakeholders. Methods for summarising the survival of a patient population with incomplete follow-up in terms of the mean and median survival times are proposed. A cure fraction model with two sets of random effects for regional variation is fitted to cause-specific survival data in a Bayesian framework using Markov chain Monte Carlo simulation. This hierarchical model is extended to the estimation of relative survival where the expected survival is estimated by region and considered as a random quantity. The public health impact of regional variation is quantified by the extra survival time and the number of avoidable deaths that would be gained if the patients achieved the most favourable level of relative survival. The methods proposed were applied to real data sets from the Finnish Cancer Registry. Estimates of the mean and the median survival times of colon and thyroid cancer patients, respectively, were corrected for the bias that was caused by the inherent selection of patients during the period of diagnosis with respect to their age at diagnosis. The cure fraction model allowed estimation of regional variation in cause-specific and relative survival of breast and colon cancer patients, respectively, with a parsimonious number of parameters yielding reasonable estimates also for sparsely populated hospital districts. / Tiivistelmä Syöpäpotilaiden elossaolon alueellisen vaihtelun seuraaminen on tärkeää arvioitaessa syövänhoidon oikeudenmukaista jakautumista alueittain. Kun alueet ovat pieniä tai harvaan asuttuja, alueellisen kokonaisvaihtelun satunnainen osa kasvaa merkittäväksi. Tämän väitöstutkimuksen tavoitteena on kehittää menetelmiä, joilla pystytään arvioimaan maan sisäistä alueellista vaihtelua lisäkuolleisuudessa, jonka itse syöpä potilaille aiheuttaa, ja tiivistämään alueellisen vaihtelun kansanterveydellinen merkitys mittalukuihin, jotka ottavat kilpailevan kuolleisuuden huomioon ja ovat myös päättäjien tulkittavissa. Ehdotetuilla menetelmillä voidaan potilaiden ennustetta kuvailla käyttäen elossaolo-ajan keskiarvoa ja mediaania, vaikka potilaiden seuruu olisi keskeneräinen. Potilaiden syykohtaiselle kuolleisuudelle sovitetaan bayesiläisittäin MCMC-simulaatiota hyödyntäen malli, jossa parantuneiden potilaiden osuuden kuvaamisen lisäksi alueellinen vaihtelu esitetään kahden satunnaisefektijoukon avulla. Tämä hierarkkinen malli laajennetaan suhteellisen elossaolon estimointiin, jossa potilaiden odotettu elossaolo estimoidaan alueittain ja siihen liittyvä satunnaisvaihtelu otetaan huomioon. Alueellisen vaihtelun kansanterveydellistä merkitystä mitataan elossaoloajan keskimääräisellä pidentymällä sekä vältettävien kuolemien lukumäärällä, jotka voitaisiin saavuttaa, mikäli suotuisin suhteellisen elossaolon taso saavutettaisiin kaikilla alueilla. Kehitettyjä menetelmiä käytettiin Suomen Syöpärekisterin aineistojen analysointiin. Paksusuoli- ja kilpirauhassyöpäpotilaiden elinaikojen keskiarvojen ja mediaanien estimaatit oikaistiin harhasta, joka aiheutui potilaiden luontaisesta valikoitumisesta diagnosointijakson aikana iän suhteen. Parantuneiden osuuden satunnaisefektimalli mahdollisti rintasyöpäpotilaiden syykohtaisen kuolleisuuden ja paksusuolisyöpäpotilaiden suhteellisen elossaolon kuvaamisen vähäisellä määrällä parametreja ja antoi järkeenkäyvät estimaatit myös harvaan asutuille sairaanhoitopiireille.

Neste trabalho propomos a distribuição Weibull-Binomial-Negativa (WBN) considerando uma estrutura de ativação latente para explicar a ocorrência do evento de interesse, em que o número de causas competitivas é modelado pela distribuição Binomial Negativa, e os tempos não observados devido às causas seguem a distribuição Weibull. Em geral, as causas competitivas podem ter diferentes mecanismos de ativação, sendo assim os casos de primeira ativação, última ativação e ativação aleatória foram considerados no estudo. Desse modo o modelo proposto inclui uma ampla distribuição, tais como Weibull-Geométrico (WG) e Exponencial-Poisson Complementar (EPC), introduzidas por Barreto-Souza et al. (2011) e G. et al. (2011), respectivamente. Baseando-nos na mesma estrutura, consideramos o modelo de regressão locação-escala baseado na distribuição proposta (WBN) e o modelo para dados de sobrevivência com fração de cura. Os principais objetivos deste trabalho é estudar as propriedades matemáticas dos modelos propostos e desenvolver procedimentos de inferências desde uma perspectiva clássica e Bayesiana. Além disso, as medidas de diagnóstico Bayesiana baseadas na \'psi\'-divergência (Peng & Dey, 1995; Weiss, 1996), que inclui como caso particular a medida de divergência Kullback-Leibler (K-L), foram consideradas para detectar observações influentes / In this work we propose the Weibull-Negative-Binomial (WNB) considering a latent activation structure to explain the occurrence of an event of interest, where the number of competing causes are modeled by the Negative Binomial distribution and the no observed time due to the causes following the Weibull distribution. In general, the competitive causes may have different activation mechanisms, cases of first, last and random activation were considered in the study. Thus, the proposed model includes a wide distribution such as Weibull-Geometric distribution (WG) and Exponential-Poisson complementary (EPC) introduced by (Barreto-Souza et al., 2011) and (G. et al., 2011) respectively. Based on the same structure, we propose a location-scale regression model based on the proposed distribution (WNB) and the model for survival data with cure fraction. The main objectives of this work is to study the mathematical properties of the proposed models and develop procedures inferences from a classical and Bayesian perspective. Moreover, the Bayesian diagnostic measures based on the \'psi\'-divergence (Peng & Dey, 1995; Weiss, 1996), which includes Kullback-Leibler (K-L) divergence measure as a particular case, were considered to detect influential observations