Censored survival data are common in clinical trials, but small control groups can pose challenges, particularly in rare diseases or where balanced randomization is impractical. Recent approaches leverage external controls from historical studies or real-world data to strengthen treatment evaluation for survival outcomes. However, using external controls directly may introduce biases due to data heterogeneity. We propose a doubly protected estimator for the treatment-specific restricted mean survival time difference that is more efficient than trial-only estimators and mitigates biases from external data. Our method adjusts for covariate shifts via doubly robust estimation and addresses outcome drift using the DR-Learner for selective borrowing. The approach can incorporate machine learning to approximate survival curves and detect outcome drifts without strict parametric assumptions, borrowing only comparable external controls. Extensive simulation studies and a real-data application evaluating the efficacy of Galcanezumab in mitigating migraine headaches have been conducted to illustrate the effectiveness of our proposed framework.

Individualized treatment rules/recommendations (ITRs) aim to improve patient outcomes by tailoring treatments to the characteristics of each individual. However, in high-dimensional treatment settings, existing methods face significant challenges due to data sparsity within treatment groups and highly unbalanced covariate distributions across groups. To address these challenges, we propose a novel calibration-weighted treatment fusion procedure that robustly balances covariates across treatment groups and fuses similar treatments using a penalized working model. The fusion procedure ensures the recovery of latent treatment group structures when either the calibration model or the outcome model is correctly specified. In the fused treatment space, practitioners can seamlessly apply state-of-the-art ITR learning methods with the flexibility to utilize a subset of covariates, thereby achieving robustness while addressing practical concerns such as fairness. We establish theoretical guarantees, including consistency, the oracle property of treatment fusion, and regret bounds when integrated with multi-armed ITR learning methods such as policy trees. Simulation studies show superior group recovery and policy value compared to existing approaches. We illustrate the practical utility of our method using EHR-derived data from patients with Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma.