Causal Inference for Survival Analysis

TL;DR

This paper introduces a novel method combining causal inference and tree ensemble models to estimate and compare survival functions at the individual level, specifically applied to breast cancer patient data.

Contribution

It develops a two-step approach using causal trees and survival forests to estimate heterogeneous treatment effects on survival outcomes at the individual level.

Findings

Effective estimation of patient-specific survival curves

Identification of causally important features for treatment effects

Application to real-world breast cancer data

Abstract

In this paper, we propose the use of causal inference techniques for survival function estimation and prediction for subgroups of the data, upto individual units. Tree ensemble methods, specifically random forests were modified for this purpose. A real world healthcare dataset was used with about 1800 patients with breast cancer, which has multiple patient covariates as well as disease free survival days (DFS) and a death event binary indicator (y). We use the type of cancer curative intervention as the treatment variable (T=0 or 1, binary treatment case in our example). The algorithm is a 2 step approach. In step 1, we estimate heterogeneous treatment effects using a causalTree with the DFS as the dependent variable. Next, in step 2, for each selected leaf of the causalTree with distinctly different average treatment effect (with respect to survival), we fit a survival forest to all the patients in that leaf, one forest each for treatment T=0 as well as T=1 to get estimated patient level survival curves for each treatment (more generally, any model can be used at this step). Then, we subtract the patient level survival curves to get the differential survival curve for a given patient, to compare the survival function as a result of the 2 treatments. The path to a selected leaf also gives us the combination of patient features and their values which are causally important for the treatment effect difference at the leaf.