Videogame helps kids blast at their cancer

August 4, 2008

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Megan Ogilvie
HEALTH REPORTER

The robot zips through the body, up blood vessels and down organs, on the look out for stray cancer cells and spots of infection. When Roxxi spies a mutant cell, she quickly zaps it with an electric green current of chemotherapy. It disintegrates and Roxxi fires up her jet pack to continue her fight against cancer.

This nanobot, who sports a fashionable bob and sleek silver spacesuit, is a character in Re-Mission, a video game specifically designed for young cancer patients. And a study, published today in the journal Pediatrics, found it can help them battle their disease.

The game is meant to promote healthy and positive behaviours in teenagers with cancer. Teens who played the game, even for one hour a week, were more likely to consistently take their chemotherapy drugs and antibiotics than those in the control group. They also learned more about their cancer and its associated side effects, and reported feeling in better control of their disease.

For Alexandra Tirabassi, playing Re-Mission was a welcome escape from the daily onslaught of cancer treatment at McMaster Children's Hospital in Hamilton.

"I know for sure when I played the game it helped me take my mind off the illness," said Tirabassi, of Fonthill, north of St. Catharines.

"I got lost in the game."

Dr. Ronald Barr, a pediatric oncologist at McMaster, was in charge of the Re-Mission study in Hamilton, one of six Canadian centres to participate in the study.

He said the preliminary success with Re-Mission, which is still being used at the hospital, has opened up a whole new area of research for ways to communicate with teens with cancer, a group who he says often slips between the cracks of pediatric and adult cancer centres.

"We have to think outside the box," said Barr, who is also a professor of pediatrics, pathology and medicine at McMaster's Michael G. DeGroote School of Medicine. "We need to be a lot more imaginative about how we influence people's behaviour to have positive impacts on their health."

Tirabassi, now 18, was diagnosed with acute lymphoblastic leukemia five years ago. Re-Mission not only helped her understand how cancer affected her body, but also what her fellow patients at McMaster were going through.

"You don't just learn about the one you have, it gives you a broader understanding of cancer," said Tirabassi who has been cancer-free for two-and-a-half years and heads to Niagara College in September to study broadcast journalism. "I got quite educated about the different forms of cancer, what and where they attacked in the body."

While Tirabassi said she was too old to imagine a flying robot inside her body that shot chemotherapy at bad cells, it did make her feel better about beating cancer.

"It's definitely a good idea for patients to experience it."

Dr. Paul Nathan, a staff physician in the division of oncology at The Hospital for Sick Children, called the study "encouraging" since it suggested video games could be used to connect with an especially vulnerable group of patients. Technology savvy teens may respond better to video games than a traditional face-to-face conversation with a physician, he said.

"This may be a more effective way for them to understand and embrace cancer treatment."

However, he said, the issue needs further study to pinpoint the precise group of patients who will best respond to video games, pointing out it won't work for everybody. Only 28 per cent of the participants played Re-Mission for the prescribed one hour per week.

"Visualizing the battle helped give them a sense of power and control over cancer," said Dr. Steve Cole, the study's co-author and vice president of research at HopeLab, the California-based non-profit organization that designed the game. "That helps them to be the victor instead of the victim of cancer."

The study suggests that feeling of increased control likely motivated patients to take greater charge of their health, most importantly to consistently take their oral chemotherapy and antibiotics.

"This is the strongest evidence to date that video games are not just entertainment, but powerful tools that can impact behaviour and be important for health," said Cole, who is also an associate professor at the UCLA School of Medicine's department of hematology-oncology.

Experts say Re-Mission may provide a new way to connect with and educate teenage cancer patients, a group that often fails to adhere to specific treatment regimes, including oral chemotherapy.

Children and teens who are diagnosed with acute lymphoblastic leukemia, the most common type of childhood cancer, for example, must take oral chemotherapy for two years after their initial hospital treatment. At first, patients consistently take the drugs, but adherence can wane over time, said Cole, especially as they start to feel better and want to get back to a normal teenage life.

But research has shown skipping oral chemotherapy can lower chances of survival. Even missing 20 to 30 per cent of doses can increase the risk of relapse two- to threefold, said Cole.

"We've got the drugs, but they're not going to work if the kids aren't going to take them," he said.

"What we do in the game is make it clear to people that this behaviour – taking the follow-up chemo, monitoring side effects – is important at a biological level. It shows you the battle still going on in your body, and what you need to do for a dramatic triumph over cancer."

In the largest study of how a video game can impact health to date, the researchers followed 375 teens and young adults with cancer at 34 medical centres in the U.S., Australia and Canada. Patients were given a computer with either the Re-Mission game or a commercially available Indiana Jones game.

After three months, patients who played Re-Mission had higher levels of chemotherapy in their blood, a sign they were consistently taking their oral chemotherapy, and were taking their antibiotics more regularly than the control group. Patients playing Re-Mission could also answer more questions about their disease and reported a greater sense of control over cancer.

To win Re-Mission, patients use Roxxi to fight cancer, including osteosarcoma, brain tumours and different types of leukemia and lymphoma, in virtual patients. Roxxi ensures the virtual patients engage in positive self-care behaviours, such as taking oral chemotherapy, and other drugs to prevent constipation, nausea and infections.

Cole said HopeLab is planning to investigate whether video games can help kids and teens with other diseases that can be improved by positive changes in behaviour, such as obesity, depression, sickle cell anemia and autism.

Toronto Star

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