OncoSynth: Synthetic data generation for treatment effect estimation in oncology

Synthetic tabular data are often evaluated by distributional similarity, privacy distance, or train-on-synthetic-test-on-real predictive performance, but these criteria do not ensure validity for causal inference. We show that fully generative tabular synthesizers, including GAN- and LLM-based models, can preserve predictive utility while distorting average treatment effect (ATE) estimates. The failure is structural: ATE preservation requires both a realistic covariate law and an accurate treatment-effect contrast, whereas prediction loss penalizes treatment-effect error only through an overlap-weighted term. Thus, under imbalance or limited overlap, a generator may reproduce dominant observed outcomes while underlearning intervention-relevant contrasts. We formalize this mismatch through sensitivity and loss-decomposition results. Motivated by this causal analysis and intuition, we propose a hybrid synthetic-data framework for causal inference that generates covariates while modeling treatment and outcome mechanisms separately. We evaluate the framework in three settings: ATE preservation under fully generative versus hybrid synthesis, augmentation for practical positivity problems, and diagnostic simulation engines for comparing OR, IPW, AIPW, and TMLE before real-data analysis. We also stress-test the hybrid construction across settings that vary overlap, covariate dimension, seed sample size, and treatment-effect complexity, including a logistic outcome-model misspecification check. Across controlled simulation experiments, hybrid synthesis improves causal fidelity relative to fully generative baselines; the ACTG application shows improved predictive fidelity and potential for finite-sample estimator benchmarking. LLM-based hybrid synthesis is often more faithful than CTGAN in settings where causal fidelity can be assessed.

Survival analysis models time-to-event data, but in clinical settings training data are costly and scarce: events accrue over years of follow-up, cohorts are small, and privacy regulations restrict sharing across institutions. Tabular generative models promise augmentation and privacy-preserving cohort sharing, yet are themselves data-hungry -- on the small cohorts typical of survival analysis, a single generator rarely characterizes the population well enough for downstream models trained on its output to match real-data performance. FoGS (Filtered Mixture-of-Generators for Survival analysis) reframes synthetic-data construction as sample selection rather than generation. A candidate pool is drawn from four architecturally distinct tabular generators, and each sample is scored by an ensemble of seven survival models trained on real data, using proper scoring rules as a per-sample plausibility proxy. A two-level pipeline optimizes, in its outer loop, a selection policy -- generator quotas, scorer weights, a random complement, and stratified balancing on event time and censoring -- against held-out downstream performance, while an inner loop tunes the downstream model (XGBoost-Cox). On 16 public datasets under train-on-synthetic, test-on-real (C-index and IBS, $0$--$100$ scale), FoGS yields mean improvements of $+2.17$ in C-index and $+0.67$ in IBS, improving both metrics on 9 of 16 datasets and at least one on 13 (one-sided Wilcoxon $p=0.039$ and $p=0.035$). It matches or exceeds real-data training on most cohorts, with no significant change in nearest-neighbour privacy margin relative to unfiltered sampling. Sample filtering over a heterogeneous generator pool is thus a viable substitute for real-data training in privacy-restricted clinical settings.

Synthetic data is widely used in healthcare to create datasets that preserve statistical properties of real data without exposing sensitive patient information. Generating and evaluating synthetic data across privacy, utility, and fairness dimensions is crucial for enabling high-quality data availability in downstream prediction tasks and clinical decision making. We present \textbf{Memisis}, a tool that orchestrates and evaluates synthetic data by leveraging existing synthesis libraries, large language models (LLMs), and state-of-the-art evaluation metrics. Our tool creates a unified workflow for data generation, validation, and evaluation. Users can control training size, training epochs, and the number of synthetic rows to sample. Beyond manual configuration, an interactive agent mode allows users to specify data generation goals in natural language, and the tool orchestrates the full pipeline by invoking existing synthesizers while performing the requisite evaluation. For the demo, we use an open-source schizophrenia dataset with protected attributes related to race and gender, evaluate six synthesizers spanning GANs, VAEs, diffusion models, and normalizing flows, and use a local LLM to orchestrate the workflow. The system affords users flexibility and control over the data generation and evaluation process.