Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. e305-e317 (doi:10.1542/10.1542/peds.2007-3134)
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ARTICLE

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

Pamela M. Kato, PhD, EdMa,b, Steve W. Cole, PhDb, Andrew S. Bradlyn, PhDc and Brad H. Pollock, PhD, MPHd

a Department of Pediatrics, Stanford Hospital, Stanford, California
b HopeLab Foundation, Redwood City, California
c Health Research Center, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
d Department of Epidemiology and Biostatistics, School of Medicine, and San Antonio Cancer Institute, University of Texas Health Science Center, San Antonio, Texas

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.

Key Words: adherence • cancer • video game • adolescent • pediatric oncology • randomized trial

Abbreviations: AYA—adolescents and young adults • 6-MP—6-mercaptopurine • TMP/SMX—trimethoprim-sulfamethoxazole • 6MMP—methylmercaptopurine nucleotides • 6-TG—6-thioguanine nucleotides • MEMS—Medication Event Monitoring System • CDCI—Chronic Disease Compliance Instrument

Accepted Apr 7, 2008.


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