Video game helps cancer patients 13-29 adhere to treatment

SAN ANTONIO (Aug. 4, 2008)—Re-Mission™, a video game for cancer patients ages 13-29, is an effective way to improve adherence to oral chemotherapy regimens, antibiotic therapy and other survival-affecting behaviors in this young and at-risk population, according to a clinical research study described in today’s issue of Pediatrics.

Brad H. Pollock, M.P.H., Ph.D., chairman of epidemiology and biostatistics at The University of Texas Health Science Center at San Antonio and member of the Cancer Therapy & Research Center at the UT Health Science Center, is the senior author on the paper and has been a key collaborator through the research and development of the Re-Mission video game.

How Re-Mission was tested
The study enrolled 375 male and female patients in 2004 and 2005 at 34 medical centers and community practices in the U.S., Canada and Australia. Of those patients, 304 finished the study. Re-Mission was pilot-tested at CHRISTUS Santa Rosa Children’s Hospital in San Antonio.

Patients were randomly assigned to play either Re-Mission and another adventure game or the adventure game alone. The groups were interviewed one month later and again at three months. All participants were asked to play their video game computer at least one hour a week.

Key behavioral and psychological outcomes were measured: how many times subjects opened their pill vials as recorded by an electronic counter in the cap, blood levels of chemotherapy, cancer-related knowledge, and “self-efficacy”—subjects’ perception of their ability to take care of themselves.

A feeling of invincibility
“Think about the general issue of adolescence and young adulthood,” Dr. Pollock said. “It is tough to get young people this age to do anything an adult wants them to do. Even if they get cancer, these kids think they are invulnerable; they don’t know their limitations. They are told to show up for clinic visits or to take a very controlled regimen of drugs at certain times, and many kids don’t do it. This intervention may significantly increase the likelihood that a young patient stays on his or her prescribed regimen.”

In the study, participants who played Re-Mission:

• maintained significantly higher levels of chemotherapy in the blood
• took their antibiotics more consistently
• showed faster acquisition of cancer-related knowledge (by 230 percent)
• showed faster increase in self-efficacy (by 370 percent)

Dr. Pollock assisted HopeLab, the nonprofit organization that sponsored the study, in the development of Re-Mission. A HopeLab press release describes the game this way: “Players pilot a nanobot named Roxxi as she travels through the bodies of fictional cancer patients destroying cancer cells, battling bacterial infections, and managing the effects of cancer and cancer treatments.”

International effect
HopeLab has distributed 125,000 copies of the Re-Mission game free of charge to cancer patients, families, hospitals and other groups in 80 countries. HopeLab suggests a $20 donation for those not in such categories. The game may be downloaded or ordered at www.re-mission.net.

“No one has engineered a game like this from the ground up that is designed to incorporate specific concepts of cancer care across to patients,” Dr. Pollock said. “This game was what we call ‘rationally engineered.’ It was designed to target specific outcomes and developed based on what we learned from focus groups of physicians, oncology nurses and patients.”

Serious use of a game
He said the findings reveal that “serious gaming,” the use of game technology for applications other than pure recreation, can play a key role in reducing mortality in this population of cancer patients. Re-Mission may be the first behavioral intervention specifically targeted at adolescents and young adults with cancer.

Teenagers ages 13-18 made up 85 percent of the study population. Males outnumbered females 2 to 1, and enrollment of Hispanics and other minorities totaled 44 percent. Diagnoses included acute lymphoblastic leukemia, acute myelogenous leukemia, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, brain tumors, osteosarcomas, Ewing sarcoma and other types of cancer.

HopeLab sponsored the research and development of the Re-Mission game.

The University of Texas Health Science Center at San Antonio is the leading research institution in South Texas and one of the major health sciences universities in the world. With an operating budget of $576 million, the Health Science Center is the chief catalyst for the $15.3 billion biosciences and health care sector in San Antonio’s economy. The Health Science Center has had an estimated $35 billion impact on the region since inception and has expanded to six campuses in San Antonio, Laredo, Harlingen and Edinburg. More than 23,000 graduates (physicians, dentists, nurses, scientists and allied health professionals) serve in their fields, including many in Texas. Health Science Center faculty are international leaders in cancer, cardiovascular disease, diabetes, aging, stroke prevention, kidney disease, orthopaedics, research imaging, transplant surgery, psychiatry and clinical neurosciences, pain management, genetics, nursing, allied health, dentistry and many other fields. For more information, visit www.uthscsa.edu.



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