The ''Re-Mission'' games for young cancer patients were conceived by Pam Omidyar and designed based research by the nonprofit HopeLab Foundation, with direct input from young cancer patients and oncology doctors and nurses, and game developer

Realtime Associates Realtime Associates is an American video game developer and publisher. The company was founded in 1986 by David Warhol and a group of ex-Mattel Electronics employees originally to create games for the Intellivision system. Since then, the compa ...

, among others. The games engage young cancer patients through entertaining game play while impacting specific psychological and behavioral outcomes associated with successful cancer treatment. HopeLab has made ''Re-Mission'' games available at no charge to young people with cancer and their families, as well as oncology healthcare workers and institutions around the world.

''Re-Mission''

The original ''Re-Mission'' game was released in 2006 as a

Microsoft Windows Windows is a group of several proprietary graphical operating system families developed and marketed by Microsoft. Each family caters to a certain sector of the computing industry. For example, Windows NT for consumers, Windows Server for serv ...

based

third-person shooter Third-person shooter (TPS) is a subgenre of 3D shooter games in which the gameplay consists primarily of shooting. It is closely related to first-person shooters, but with the player character visible on-screen during play. While 2D shoot 'em ...

based in the

serious games A serious game or applied game is a game designed for a primary purpose other than pure entertainment. The "serious" adjective is generally prepended to refer to video games used by industries like defense, education, scientific exploration, he ...

genre. In ''Re-Mission'', the player controls an RX5-E ("Roxxi")

nanobot Nanoid robotics, or for short, nanorobotics or nanobotics, is an emerging technology field creating machines or robots whose components are at or near the scale of a nanometer (10−9 meters). More specifically, nanorobotics (as opposed to mic ...

who is designed to be injected into the human body and fight particular types of cancer and related infections such as

non-Hodgkin lymphoma Non-Hodgkin lymphoma (NHL), also known as non-Hodgkin's lymphoma, is a group of blood cancers that includes all types of lymphomas except Hodgkin lymphomas. Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and tiredness. ...

and

leukemia Leukemia ( also spelled leukaemia and pronounced ) is a group of blood cancers that usually begin in the bone marrow and result in high numbers of abnormal blood cells. These blood cells are not fully developed and are called ''blasts'' or ' ...

, at a

cellular Cellular may refer to: *Cellular automaton, a model in discrete mathematics * Cell biology, the evaluation of cells work and more * ''Cellular'' (film), a 2004 movie *Cellular frequencies, assigned to networks operating in cellular RF bands *Cell ...

level. The player must also monitor patient health and report any symptoms back to Dr. West (the in-game doctor and project leader). Each of the 20

levels Level or levels may refer to: Engineering *Level (instrument), a device used to measure true horizontal or relative heights *Spirit level, an instrument designed to indicate whether a surface is horizontal or vertical *Canal pound or level *Regr ...

is designed to inform the patient on a variety of treatments, how they function, and the importance of maintaining strict adherence to those treatments. Various "weapons" are used, such as the Chemoblaster, Radiation Gun, and antibiotic rocket. Copies of ''Re-Mission'' were distributed at no charge to others, though donations were accepted. As of 2012, more than 200,000 copies of ''Re-Mission'' had been distributed in 81 countries, placing it among the most successful serious games to date. HopeLab engaged organizations and individuals worldwide to facilitate distribution of the game to teens and young adults with cancer. On May 30, 2007, Cigna HealthCare announced a partnership with HopeLab in which Cigna distributes copies of ''Re-Mission'' to its members at no cost. HopeLab has also partnered with Starlight Children's Foundation and the

ESA , owners = , headquarters = Paris, Île-de-France, France , coordinates = , spaceport = Guiana Space Centre , seal = File:ESA emblem seal.png , seal_size = 130px , image = Views in the Main Control Room (1205 ...

Foundation to distribute Re-Mission.

''Re-Mission 2''

''Re-Mission 2 is'' the 2013 follow-up to the original game. A collection of free online games, ''Re-Mission 2'' is designed to improve psychological and behavioral outcomes associated with cancer treatment adherence. Each game puts players inside the body to fight cancer with weapons like chemotherapy, antibiotics and the body's natural defenses. Game play parallels real-world strategies used to fight cancer and win. More than 120 young people with cancer participated in the research and development of the games. ''Re-Mission 2'' applies insights from
brain-imaging study
published in 2012 by HopeLab and Stanford University researchers, showing that the Re-Mission video game strongly activates brain circuits involved in positive motivation. This reward-related activation is associated with a shift in attitudes and emotions that helped boost players’ adherence to prescribed chemotherapy and antibiotic treatments in a previous study. As a result, each ''Re-Mission 2'' game is designed to boost positive emotion, increase self-efficacy, and shift attitudes toward chemotherapy. Each ''Re-Mission 2'' game puts players inside the body to defeat cancer, using weapons like chemotherapy, antibiotics and the body's immune cells. The games are designed specifically for teens and young adults who are at risk of adverse cancer outcomes due to poor treatment adherence. Research on ''Re-Mission 2'' shows that the new games are as effective as the original ''Re-Mission'' game in increasing players’ self-efficacy, boosting positive emotions and shifting attitudes about chemotherapy. ''Re-Mission 2'' games are free to play online a
re-mission2.org
and ''Re-Mission 2: Nanobot’s Revenge'' is available for download as
mobile app for iOS
an
Android
devices. The browser-based games and mobile app offer a variety of game play styles for young cancer patients who spend time online and on mobile devices.

Research

HopeLab conducted an international, multicenter randomized controlled trial to gauge the efficacy of Re-Mission as it relates to compliance with prescribed

chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemotherap ...

and

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...

treatments, cancer-related knowledge, and

self-efficacy In psychology, self-efficacy is an individual's belief in their capacity to act in the ways necessary to reach specific goals. The concept was originally proposed by the psychologist Albert Bandura. Self-efficacy affects every area of human endea ...

. The study enrolled 375 cancer patients aged 13–29 at 34 medical centers in the United States, Canada and Australia. Subjects received either computers pre-loaded with a popular commercial video game (the

control group In the design of experiments, hypotheses are applied to experimental units in a treatment group. In comparative experiments, members of a control group receive a standard treatment, a placebo, or no treatment at all. There may be more than one tr ...

) or computers preloaded with the same control game plus Re-Mission. Study results indicated that playing Re-Mission led to more consistent treatment adherence, faster rate of increase in cancer knowledge, and faster rate of increase in self-efficacy in young cancer patients. These findings were published in August 2008 in the

peer-reviewed Peer review is the evaluation of work by one or more people with similar competencies as the producers of the work (peers). It functions as a form of self-regulation by qualified members of a profession within the relevant field. Peer review ...

medical journal ''

Pediatrics Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until th ...

''. Notably, to ascertain treatment compliance, researches used objective

blood tests A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a hypodermic needle, or via fingerprick. Multiple tests for specific blood components, such as a glucose test or a cholester ...

to measure levels of prescribed chemotherapy in the bodies of study participants rather than subjective

self-report A self-report study is a type of survey, questionnaire, or poll in which respondents read the question and select a response by themselves without any outside interference. A ''self-report'' is any method which involves asking a participant abou ...

questionnaires, and electronic pill-cap monitors were used to determine utilization of prescribed antibiotics. Researchers concluded that a carefully designed video game can have a positive impact on health behavior in young people with chronic illness and that video-game–based interventions may constitute a component of a broader integrative approach to healthcare that synergistically combines rationally targeted biological and behavioral interventions to aid patients in the prevention, detection, treatment, and recovery from disease. HopeLab conducted additional research to understand the

mechanisms of action In pharmacology, the term mechanism of action (MOA) refers to the specific biochemical interaction through which a drug substance produces its pharmacological effect. A mechanism of action usually includes mention of the specific molecular targe ...

that make ''Re-Mission'' effective. Results of an

fMRI Functional magnetic resonance imaging or functional MRI (fMRI) measures brain activity by detecting changes associated with blood flow. This technique relies on the fact that cerebral blood flow and neuronal activation are coupled. When an area o ...

study of ''Re-Mission'' showing the impact of the game on neurological processes were presented in August 2008 at the 10th International Congress of the Society of Behavioral Medicine. This research informed HopeLab's development of ''Re-Mission 2''.

References

{{Reflist

External links

HopeLab main site

''Re-Mission'' main site supporting game orders and online community

''Re-Mission 2'' main site supporting online game play

Ruckus Nation idea competition main site

Articles and videos

Using a Mobile App to Fight Cancer, HUFFPOST Live, November 5, 2013
*
Games for Health Keynote Speaker Steve W. Cole on ReMission
by Erin Hoffman, Serious Games Source (November, 2006) *

by Christopher Lee, The Washington Post (October 21, 2006) *
Cigna and HopeLab Team up to Bring Health Games to Medical Professionals, Patients
" Digital Journal (September 16, 2013) *
Re-Mission: game sequel lets you blast cancer cells
" USA Today (September 19, 2013) *
HopeLab: Providing Help Through Video Games
" Gaming Illustrated (September 30, 2013) *

" The Huffington Post Blog (May 20, 2013) *
HopeLab's Playful Approach to Overcoming Childhood Obesity
Smart Planet (October 30, 2009) *
Silicon Valley Nonprofit in Spotlight After Trip to White House
San Jose Mercury News (July 15, 2009) *
A Video Game Helping Kids With Cancer
CTV Toronto (August 7, 2008) *
Video Game Helps Young Cancer Patients Take Meds
Reuters (August 5, 2008) *
Startup Uses Video Games to Heal Young People
San Francisco Chronicle (August 4, 2008) *
Video Game Helps Kids Blast at Their Cancer
Toronto Star (August 4, 2008) *
Study Shows Video Games Can Change Behavior, Biology
Press Release (August 4, 2008) *
A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial
Pediatrics (August 2008) *
OMG! Denver Girls Txt It! Game Is Winner
Denver Post (March 30, 2008) *
Winners Announced in HopeLab’s Global Competition to Get Kids Moving!
Press Release (March 17, 2008) *
F as in Fat: How Obesity Policies are Failing in America
Trust for America's Health (August 2007) *
2005-2006 President's Cancer Panel report
2006 video games Educational video games Oncology Third-person shooters Video games developed in the United States Windows games Windows-only games Realtime Associates games