A multistate model incorporating estimation of excess hazards and multiple time scales

As cancer patient survival improves, late effects from treatment are becoming the next clinical challenge. Chemotherapy and radiotherapy, for example, potentially increase risk of both morbidity mortality second malignancies cardiovascular disease. To provide clinically relevant population-level measures effects, it is importance to (1) simultaneously estimate risks mortality, (2) partition these into component expected in absence due its treatment, (3) incorporate multiple time scales attained age, calendar time, since diagnosis. Multistate models a framework studying but do not solve problem partitioning risks. However, this can be achieved by applying relative framework, allowing us directly quantify excess risk. This article proposes combination two frameworks, providing one approach address (3). Using recently developed methods multistate modeling, we estimation hazards model. Both intermediate absorbing state partitioned different transitions allowed have and/or scales. We illustrate our using data on Hodgkin lymphoma patients diseases circulatory system, user-friendly Stata software with accompanying example code.