Cited by 802Medication Adherence and ComplianceEducational Games and GamificationChildhood Cancer Survivors' Quality of Life

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A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial

Kato, Pamela M., Cole, Steve W., Bradlyn, Andrew S., Pollock, Brad H.·2008·Pediatrics

DOI 10.1542/peds.2007-3134

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Abstract

OBJECTIVE. Suboptimal adherence to self-administered medications is a common problem. The purpose of this study was to determine the effectiveness of a video-game intervention for improving adherence and other behavioral outcomes for adolescents and young adults with malignancies including acute leukemia, lymphoma, and soft-tissue sarcoma. METHODS. A randomized trial with baseline and 1- and 3-month assessments was conducted from 2004 to 2005 at 34 medical centers in the United States, Canada, and Australia. A total of 375 male and female patients who were 13 to 29 years old, had an initial or relapse diagnosis of a malignancy, and currently undergoing treatment and expected to continue treatment for at least 4 months from baseline assessment were randomly assigned to the intervention or control group. The intervention was a video game that addressed issues of cancer treatment and care for teenagers and young adults. Outcome measures included adherence, self-efficacy, knowledge, control, stress, and quality of life. For patients who were prescribed prophylactic antibiotics, adherence to trimethoprim-sulfamethoxazole was tracked by electronic pill-monitoring devices (n = 200). Adherence to 6-mercaptopurine was assessed through serum metabolite assays (n = 54). RESULTS. Adherence to trimethoprim-sulfamethoxazole and 6-mercaptopurine was greater in the intervention group. Self-efficacy and knowledge also increased in the intervention group compared with the control group. The intervention did not affect self-report measures of adherence, stress, control, or quality of life. CONCLUSIONS. The video-game intervention significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy. The findings support current efforts to develop effective video-game interventions for education and training in health care.

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“(2014) research explored the role of video games in alleviating patient suffering as well as studies beginning to design video games as a medium for young cancer patients to learn about their diseases and treatments (Kato et al., 2008).”
Background
A serious game-based platform for measuring treatment adherence
Damasceno, E. F., da Silva, A. P., & Barbosa, J. D. (2023) · Multimedia Tools and Applications · doi:10.1007/s11042-023-15988-5 · Cited by 6
“To improve treatment adherence and behavioral outcomes in malignant diseases, including acute leukemia, lymphoma, and soft tissue sarcoma, Kato et al. (2008) [13] conducted a trial that showed the effectiveness of using video games.”
Effects of the re-mission video game on fatigue and quality of life levels of adolescents diagnosed with cancer: a randomized controlled trial
Uluhan, C., & Didişen, N. A. (2023) · Psychology Health & Medicine · doi:10.1080/13548506.2023.2289471 · Cited by 6
“In another study in which the same video game was used, there was an increase in the mean quality of life scores, but this increase was not statistically significant (Kato et al., 2008).”
Background
A mobile serious game for lifestyle change: Conveying nutritional knowledge and motivation through play
Dunwell, I., Dixon, R., & Morosini, D. (2015) · International Conference on Interactive Mobile Communication, Technologies and Learning · doi:10.1109/imctl.2015.7359599 · Cited by 6
“The notion of using games to stimulate healthy behaviours has been applied in a wide variety of contexts, ranging from their use to convey dietary knowledge and impact food choices amongst younger children [7], to ensuring treatment adherence in adolescents [8].”
Background
Development and Validation of a Risk Assessment Tool for Gaming Disorder in China: The Gaming Hazard Assessment Scale
Tang, Y., Liao, Z., Huang, S., Hao, J., Huang, Q., Chen, X., Lin, S., Li, Y., Qi, J., & Shen, H. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.870358 · Cited by 7
Decision-Making Game for Simulation of Breast Cancer Biopsy and Treatment
Barbosa, R. G., Rodriguês, M. A. F., de Oliveira, T. R. C., Madeira, S. P., Figueiredo, J. A. D., Alves, M. S., Medeiros, M. A. S., & Filho, R. L. C. (2022) · SeGAH ... IEEE ... International Conference on Serious Games and Applications for Health/IEEE International Conference on Serious Games and Applications for Health · doi:10.1109/segah54908.2022.9978558 · Cited by 6
“Other examples are Re-Mission [22], designed to provide cancer support, empower players, and encourage treatment adherence, and Ben’s Game [23], focused on destroying mutated cells and collecting protective shields for the main side effects of the treatment, such as hair loss.”
Background
Medication self-management behaviors of adolescents and young adults with cancer
Erickson, J. M., Kamke-Jordan, A., Lancaster, I. J., Palou‐Torres, A., Esch, M., Gonzalez, A., Charlson, J. A., & Bingen, K. M. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-023-07863-8 · Cited by 6
Play to Learn: from Serious Games to just Games
Franceschini, A., & Rodà, A. (2023) · International Conference on Information Technology for Social Good (GoodIT) · doi:10.1145/3582515.3609525 · Cited by 8
Assessing the Impact of a Serious Game (MedSMARxT: Adventures in PharmaCity) in Improving Opioid Safety Awareness Among Adolescents and Parents: Quantitative Study
Abraham, O., McCarthy, T. J., & Zaborek, J. (2023) · JMIR Formative Research · doi:10.2196/51812 · Cited by 6
Monitoring player attention: A non-invasive measurement method applied to serious games
Osman, Z. M., Dupire, J., Mader, S., Cubaud, P., & Natkin, S. (2015) · Entertainment Computing · doi:10.1016/j.entcom.2015.08.003 · Cited by 6
“Using games in therapy is seen as a promising solution because they can motivate the player, motivation being a major challenge in a therapeutic context [11,18].”
Background
Pegaso: A Serious Game to Prevent Obesity
Pannese, L., Morosini, D., Lameras, P., Arnab, S., Dunwell, I., & Becker, T. (2014) · Lecture notes in computer science · doi:10.1007/978-3-319-07725-3_43 · Cited by 6
“Controlled trials for game-based interventions such as Re-Mission demonstrates effectiveness in the support for medication adherence in children with cancer [21], and PR:EPARe shows positive outcomes in changed attitudes towards the issue of sexual coercion and pressure in adolescence relationships [22].”
Background
Serious Games—Economic and Legal Issues
Göbel, S. P., Hugo, O., Kickmeier-Rust, M., & Egenfeldt‐Nielsen, S. (2016) · Springer eBooks · doi:10.1007/978-3-319-40612-1_11 · Cited by 6
Acceptability of Group Visits for Attention-Deficit Hyperactivity Disorder in Pediatric Clinics
Bauer, N. S., Azer, N., Sullivan, P. D., Szczepaniak, D., Stelzner, S. M., Downs, S. M., & Carroll, A. E. (2017) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000492 · Cited by 6
Conducting Scientific Research on Learning and Health Behavior Change with Computer-Based Health Games.
Mayer, R. E., & Lieberman, D. A. (2011) · Educational Technology archive · Cited by 6
Deep assessment: an exploratory study of game-based, multimodal learning in Epidemic
Jenson, J., de Castell, S., Thumlert, K., & Muehrer, R. (2016) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 6
A Virtual Pet Serious Game in Motivating Children with Cancer in Treatment and Self-Care: A Conceptual Design
Er, C. C. W., Lau, B. T., Mahmud, A. A., & Tsun, M. T. K. (2020) · Malaysian Journal of Paediatrics and Child Health · doi:10.51407/mjpch.v26i2.101 · Cited by 8
“game aims to increase treatment adherence for chemotherapy medication intake, promote management of common symptoms, increase cancer-related knowledge of players, and improve self-efficacy of players to take care of themselves during cancer [32,33].”
Background
Puppy island
McEwan, M., Phillips, C. J., Wyeth, P. A., & Johnson, D. M. (2020) · ACM International Conference on Interaction Design and Children (IDC) · doi:10.1145/3392063.3394435 · Cited by 6
“Research has found that not only do children learn while playing video games [4, 26, 41, 45], serious games have been established as an effective means of engaging people with health-related activities ranging from medication adherence to physical activity [5, 24].”
Background
Edutainment in Sport and Health
Wiemeyer, J., & Tremper, L. L. (2016) · Springer eBooks · doi:10.1007/978-981-4560-50-4_67 · Cited by 6
A Game-Based Training Approach to Enhance Human Hand Motor Learning and Control Abilities
Asadipour, A., Debattista, K., & Chalmers, A. G. (2015) · International Conference on Games and Virtual Worlds for Serious Applications · doi:10.1109/vs-games.2015.7295759 · Cited by 6
“Positive behavioral changes were reported on pediatric patients who were diagnosed with cancer by playing this video game [16].”
Background
Sadistic Personality Disorder
(2012) · Springer eBooks · doi:10.1007/springerreference_223767 · Cited by 6
Videogames as Therapy: An Updated Selective Review of the Medical and Psychological Literature
Griffiths, M. D., Kuss, D. J., & Ortiz de Gortari, A. B. (2020) · Alternative Pain Management · doi:10.4018/978-1-7998-1680-5.ch014 · Cited by 5
Human‐Centered Design of a Personalized Digital Health Intervention to Improve Oral Chemotherapy Adherence in Adolescents and Young Adults With Hematologic Cancers
Psihogios, A. M., El-Khatib, A., Matos, K., Rabbi, M., Rossoff, J. E., Dinner, S. N., Zeng, K., Picos, R., Ahmed, A., Patel, E. M., et al. (2025) · Pediatric Blood & Cancer · doi:10.1002/pbc.31756 · Cited by 5
“Techquity” in Pediatric, Adolescent, and Young Adult Oncology: Addressing Inequities Through Artificial Intelligence and Immersive Technologies
Puthenpura, V., Hunter, M., & Marks, A. M. (2025) · Pediatric Blood & Cancer · doi:10.1002/pbc.31909 · Cited by 5
“This improved understanding can foster greater engagement in treatment decisions, adherence to medical advice, and overall satisfaction with care [42, 49–51].”
Digital Serious Games for Cancer Education and Behavioural Change: A Scoping Review of Evidence Across Patients, Professionals, and the Public
Si, G., Prue, G., Craig, S. G., Anderson, T. J., & Mitchell, G. (2025) · Cancers · doi:10.3390/cancers17203368 · Cited by 5
“Support for this finding was found in nine studies, comprising one qualitative study [37], four quantitative studies [31–33, A randomized controlled trial (RCT) of a video game that improves behavioural outcomes in adolescents and young adults with cancer suggested although both game groups’ or…”
Influential
Digital Technology in Health Science Education
Dev, P., & Schleyer, T. (2021) · Springer eBooks · doi:10.1007/978-3-030-58721-5_25 · Cited by 6
The effect of a peer‐assisted video‐based training programme and counselling to reduce anxiety in children newly diagnosed with cancer: Non‐randomised controlled trial
Erkul, M., Efe, E., & Güler, E. (2022) · European Journal of Cancer Care · doi:10.1111/ecc.13698 · Cited by 5
Increasing Access to Mental Health Services: Videogame Players’ Perspectives
van der Schyff, E. L., Forsyth, R., Amon, K. L., Ridout, B., & Campbell, A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20064772 · Cited by 5
“While results suggest that serious videogames have shown promising results for their intended purpose [16,17] there are significant limitations to the development and maintenance of these types of games.”
Background
Serious…ly! Just Kidding in Personalised Therapy Through Natural Interactions with Games
Madeira, R. N., Antunes, A., Postolache, O. A., & Correia, N. M. R. (2018) · Lecture notes in computer science · doi:10.1007/978-3-319-76270-8_50 · Cited by 5
Increasing motivation for cancer treatment adherence in children through a mobile educational game: a pilot study
Er, C. C. W., Theng, L. B., Tsun, M. T. K., & Mahmud, A. A. (2022) · EAI Endorsed Transactions on Pervasive Health and Technology · doi:10.4108/eai.15-2-2022.173453 · Cited by 5
“• The ability to fight cancer in a game can empower players to fight the disease and also boost treatment adherence [32]”
Background
Evaluating the Usability and Safety of Virtual Reality Application Combined with the SWalker for Functional Gait Rehabilitation
Costa, V., Rojo, A., López‐López, S., Pareja-Galeano, H., Velásquez, A., Perea, L., & Raya, R. (2024) · Games for Health Journal · doi:10.1089/g4h.2023.0172 · Cited by 5
“Computational neuroscience research has demonstrated that VR technology enhances learning by increasing patient motivation 19 and the performance of motor tasks by offering valuable feedback on movement performance.”
Analysis of decision making skills for large scale disaster response
Rose, C., Seater, R. M., & Norige, A. S. (2015) · IEEE Global Humanitarian Technology Conference (GHTC) · doi:10.1109/ghtc.2015.7343979 · Cited by 5
“The recent surge of activity in attempting to do so has had successes [4] [5] but is hampered by the lack of a systematic approach for reliably building games to match a given application.”
Background
Co-design of a Prostate Cancer Serious Game for African Caribbean Men
Cosma, G., Shopland, N., Battersby, S., Seymour‐Smith, S., Pockley, A. G., Archer, M., Thompson, R., Khan, M. A., & Brown, D. J. (2015) · International Conference on Interactive Technologies and Games (ITAG) · doi:10.1109/itag.2015.20 · Cited by 5
“Serious games can have a positive impact on the health behaviour [11], [12], [13], [14], [15] and can serve as efficient interventions for effectively communicating accurate information and supporting men in a culturally sensitive way.”
Background
A Serious Game for On-the-Ward Infection Control Awareness Training
Dunwell, I., & Jarvis, S. (2012) · Advances in healthcare information systems and administration book series · doi:10.4018/978-1-4666-1903-6.ch011 · Cited by 5
Serious game design for digital forensics training
Blažič, A. J., Cigoj, P., & Blažič, B. J. (2016) · International Conference on Digital Information Processing, Data Mining, and Wireless Communications (DIPDMWC) · doi:10.1109/dipdmwc.2016.7529391 · Cited by 5
Quelle démarche d’éducation thérapeutique (ETP) pour les adolescents et jeunes adultes atteints de cancer ? Expérience du groupe ETP de « Go-AJA »
Corradini, N., Dagorne, L., Retailleau, M., Rédiní, F., Sudour‐Bonnange, H., Gofti‐Laroche, L., Rhun, A. L., & Gaspar, N. (2016) · Bulletin du Cancer · doi:10.1016/j.bulcan.2016.10.006 · Cited by 5

Authors: Kato, P. M., Cole, S. W., Bradlyn, A. S., & Pollock, B. H.
Affiliations: Stanford Health Care (US)
HopeLab (US)
West Virginia University (US)
The University of Texas at San Antonio Health Science Center (US)
ORCID: Kato, Pamela M.
Cole, Steve W.
Pollock, Brad H.
Venue: Pediatrics
Publisher: American Academy of Pediatrics (AAP)
Published: 2008-08-01
Volume: 122
Issue: 2
Pages: e305-e317
ISSN: 0031-4005 (ISSN-L)
1098-4275
DOI: 10.1542/peds.2007-3134
OpenAlex: W2163083471
Cited by: 802
References: 71
Citations by year: 2026: 14 · 2025: 26 · 2024: 26 · 2023: 39 · 2022: 41 · 2021: 44 · 2020: 51 · 2019: 44 · 2018: 61 · 2017: 46 · 2016: 75 · 2015: 95 · 2014: 62 · 2013: 55 · 2012: 48
FWCI: 17.72
Type: journal article
Language: en
Open access: closed
Locations: PEDIATRICS (publishedVersion)
PubMed (publishedVersion)
Funders: Hopelab Foundation
National Cancer Institute (CA-054174, P30CA054174, CA95861, CA 098543, U10CA098543, U10CA095861)
Topics: Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
Keywords: video game intervention, medication adherence, adolescent and young adult cancer, self-efficacy, health knowledge, trimethoprim-sulfamethoxazole, 6-mercaptopurine, antibiotic prophylaxis, acute leukemia, lymphoma, soft tissue sarcoma, stress, quality of life, health education
MeSH terms: Adaptation, Physiological, Adaptation, Psychological, Adolescent, Adult, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Neoplasms, Patient Compliance, Patient Education as Topic, Probability, Quality of Life, Reference Values, Health Behavior, Poisson Distribution, Video Games, Self Efficacy

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A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial

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