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Competing Risks — SCE Medical Oncology MCQ

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HardClinical Trials & StatisticsCompeting RisksSCE Medical Oncology

A researcher describes the concept of 'competing risks' in oncology trials. An elderly patient enrolled in a CRC adjuvant trial dies from cardiovascular disease before experiencing cancer recurrence. How should this be handled in the analysis?

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Correct answer: D — Competing risks analysis is preferable — standard Kaplan-Meier censoring for non-cancer death overestimates the cumulative incidence of cancer recurrence; Fine-Gray models or cause-specific hazard models appropriately account for competing events

Standard KM censoring assumes the censored event (non-cancer death) is uninformative — but in elderly patients with comorbidities, non-cancer death is a competing event that prevents cancer recurrence from ever occurring. This overestimates cumulative incidence of cancer events. Competing risks methods (Fine-Gray subdistribution hazard, cumulative incidence function) correctly account for this and are increasingly required for elderly-dominated trials.

Reference: JRCPTB; Fine & Gray JASA 1999; Putter et al Stat Med 2007