Video Games for Health: A New Approach to Educating and Treating Pediatric Cancer Patients

Video games have become a way of life for many children and adolescents, made possible by the advent of game consoles (eg, Xbox, Playstation), computers, and the Internet. Although some people frown upon the amount of time some kids spend playing these games and decry their lack of educational value, the gaming industry has begun to evolve beyond solely providing entertainment and turned its attention toward designing games that address “a wide range of public and private policy, leadership, and management issues”. As part of this effort, designers are working with physicians and researchers to develop games that combine entertainment value with education in a revolutionary approach to disease management that could be particularly effective in children and adolescents. Video games may not be an instant cure, but research has demonstrated that people have the ability to learn more when engaging in an interactive game, a phenomenon that game designers hope to leverage to help improve outcomes in a variety of diseases, including cancer.

Currently, games are being developed in three categories: 1) Simulated- and virtual-reality, which can be used to alleviate anxiety and distract from pain; 2) “Exergames,” which incorporate exercise into playing; and 3) Learning games, which educate children about various health conditions. Terry Spearman, team leader for Child Life Services at the Children’s National Medical Center, says “distraction…is a well-documented technique for helping children manage anxiety and fear in the hospital,” and “video games ‘sound like another, higher-level form of distraction.’”

Numerous trials have been conducted to determine how effectively video games help patients cope with pain. According to an editorial published in the July 16, 2005 issue of the British Medical Journal, “these studies reported that distracted patients had less nausea and lower systolic blood pressure than controls (who were simply asked to rest) after treatment and needed fewer analgesics”.

Games for Health Project

The Serious Games Initiative—founded by the Woodrow Wilson Center for International Scholars based in Washington, DC—established the Games for Health Project to “help foster and support a community of researchers, developers, and users of applications that use game, game technologies, and game development talent to create entire[ly] new ways of improving the management, quality, and provision of healthcare worldwide.” Games for Health is funded by the Robert Wood Johnson Foundation and seeks to improve the health of patients through the application of video gaming and interactive multimedia technologies. The Project does this by focusing on four questions:

1. Can games improve the provision, and quality, of healthcare?
2. What existing and emerging game technologies (such as multi-user, virtual environments) might be particularly useful when applied to healthcare issues?
3. How can we expand the application of computer-based game technologies to face key challenges in the healthcare sector?
4. How do we identify and proactively deal with any social, ethical, and/or legal issues that might arise through the application of game-based tools to healthcare issues?

On September 28-29, 2006, the University of Maryland Medical Center in Baltimore hosted the third annual Games for Health conference, which brought more than 250 researchers, medical professionals, game developers, and consultants together in order “to explore how video games and game developers are driving new strategies in health care” through case studies, a demonstration expo, research, lectures, panels, and discussions about a variety of topics and projects. “Game developers have the skills to create programs that will help patients learn about disease and disease management,” said Dr. Bruce Jarrell, vice dean for academic aff airs, University of Maryland School of Medicine. “There is real promise in the video game industry to bring needed health care information to patients in a familiar and exciting format.”

Games for Pediatric Cancer Patients

The American Cancer Society estimated for 2006 that 9,500 new patients age 0-14 years would be diagnosed with cancer. These patients would then most likely undergo aggressive treatments ranging from surgery to chemotherapy to radiology, most likely accompanied by side effects (eg, nausea, rashes, hair loss) and pain that significantly diminish their quality of life. This is where video games can help, both as a distraction from the pain and as educational tools. Game designers have created several games, available in a variety of formats to meet the special needs of pediatric cancer patients.

The Degge Group, Ltd. created a game, Kidz With Leukemia: A Space Adventure, which teaches young patients about leukemia and its treatment through puzzles, games, videos, and animation. They also created an interactive CD-ROM for adolescents with solid tumors called Conquering Cancer Network: Empowering Teens with Tools, Info and Inspiring Stories. This program educates adolescents about tumors, treatment, side effects, and coping skills through music, videos, and interactive games, among other methods. Similarly, the Starlight Starbright Children’s Foundation has focused on educating “today’s tech-savvy kids” about various diseases, including cancer, “in a way that appeals to them: through the Internet”. Patients can visit the Foundation’s website to access eight video games, three of which are at least partially related to oncology and hematology: Radiology Center, Uncovering the Mysteries of Bone Marrow, and Blood Tests: Exploring Our Incredible Blood.

Ben’s Game

In the August 2006 OncNG Patient Education Resources section, we briefly profiled Ben’s Game, which was inspired by a 12-year-old leukemia patient, Ben Duskin (who has since received a bone marrow transplant and is in remission) and was made possible by the combined eff orts of the Make-A-Wish Foundation and LucasArts. During his illness, Ben turned to computer games as a way to cope with his pain and treatment side effects and wanted to create a video game to help children deal with the stress and frustration of cancer treatment. The Greater Bay Area Make-A-Wish Foundation announced on November 2, 2005 the availability of Ben’s Game for downloading in nine languages—English, Dutch, French, German, Greek, Italian, Japanese, Russian, and Spanish. The game has been downloaded more than 200,000 times worldwide since its public release on the Internet. Ben and Eric Johnston, the game’s creator and a senior software engineer and technical director at LucasArts, were honored in a meeting with the Dalai Lama in which Ben was recognized as an “Unsung Hero for Compassion” because of his generosity with this unique project.

The object of Ben’s Game is to destroy all mutated cells and collect seven shields for protection against the common side effects of chemotherapy; snow monsters represent colds, vampires represent bleeding, and cue balls represent hair loss, among others. Through three levels of diffi culty, players have the option to use a pre-created character or customize one for themselves (www.gamasutra.com/features/20050927/bogost_01.shtml) Ben’s Game is available to download in both PC and Mac versions at no charge.

Re-Mission

Game developers are also designing games to “improve cognitive functioning”. HopeLab, based in Palo Alto, CA, “is a non-profi t organization dedicated to combining rigorous research with innovative solutions to improve the health and quality of life of young people with chronic illness”. The company’s founder, Pam Omidyar, created a video game for adolescents and young adults who are battling cancer called Re-Mission. Officially released to the public in April 2006, Re-Mission is a third-person “shooter” with 20 levels featuring different types of cancer to be overcome using a nanobot named Roxxi “who destroys cancer cells, battles bacterial infections, and manages realistic, life-threatening side effects associated with cancer."

At the 27th Annual Meeting & Scientific Sessions for the Society of Behavioral Medicine in March 2006, HopeLab presented results from a trial with 375 patients age 13-29 years to determine how eff ective Re-Mission was in helping them adhere to cancer medications and increase their knowledge about cancer, quality of life, and self-efficacy. More than 80% of those who played the game increased their cancer-related knowledge, allowing them to be better able to talk about cancer and manage the side effects. Young people who played Re-Mission maintained higher blood levels of chemotherapy and showed higher rates of antibiotic utilization, both suggesting that Re-Mission helps patients adhere to cancer therapy regimens. Visit www.re-mission.net to learn more about the game; cancer patients can download a copy at no charge.

Looking Ahead

Although the majority of the games related to cancer are geared toward patients who have already been diagnosed, some focus on cancer prevention. The US Environmental Protection Agency sponsors a website called SunWise that educates site visitors on “how to protect themselves from overexposure to the sun.” Under the “Kids” section are interactive games through which children can learn about the importance of wearing sunscreen, dressing properly when going outside, and other skin cancer prevention measures.

Incorporating video games into patient treatment shows that the healthcare industry is making steps to incorporate high-technology tools into practice. Videogames and other interactive technologies provide cancer patients with the opportunity to learn more about their disease and vent their frustration and release stress during the treatment process.

Cancer Games & Information for Patients

• Ben’s Game
• Blood Tests: Exploring Our Incredible Blood
• The Cancer Game
• Kidz With Leukemia: A Space Adventure
• Re-Mission
• Radiology Center
• Uncovering the Mysteries of Bone Marrow