Considerations of Competing Risks Analysis in Cardio-Oncology Studies: JACC: CardioOncology State-of-the-Art Review

Cardio-oncology research studies often require consideration of potential competing risks, as the occurrence of other events (eg, cancer-related death) may preclude the primary event of interest (eg, cardiovascular outcome). However, the decision to conduct competing risks analysis is not always straightforward, and even when deemed necessary, misconceptions exist about the appropriate choice of analytical methods to address the competing risks. R researchers are encouraged to consider competing risks at the study design stage and are provided provide an assessment tool to guide decisions on analytical approach on the basis of study objectives. The existing statistical methods for competing risks analysis, including cumulative incidence estimations and regression modeling are also reviewed. Cardio-oncology-specific examples are used to illustrate these concepts and highlight potential pitfalls and misinterpretations. R code is also provided for these analyses.