Older patients with cancer undergoing treatment with emetogenic chemotherapy were more likely to practice preventive behaviors when they participated in an interactive, educational — ie, “serious” — game focused on the prevention and self-management of chemotherapy-induced nausea and vomiting (CINV) compared with those exposed to a standard educational approach, according to findings of a randomized study published in Oncology Nursing Forum.

Nausea and vomiting associated with the administration of moderately and severely emetogenic chemotherapeutic agents are some of the most feared side effects of cancer treatment. CINV has been associated with severe detriments in patient quality of life, as well as dehydration, fatigue, muscle weakness, and early termination of treatment, particularly among older patients with cancer. 

In this study (ClinicalTrials.gov Identifier: NCT03143829), 80 patients aged 60 years or older scheduled to receive chemotherapy for any type of newly diagnosed cancer were randomly assigned 1:1 to intervention and control groups (38 and 42 patients, respectively). All patients were scheduled to receive moderately or severely emetogenic chemotherapy in a 3-week regimen. Patients in the intervention group played a 12- to 15-minute serious game on an iPad in the treatment room before receiving their first chemotherapy treatment; then subsequently discussed outcomes with the research nurse. The control group was exposed to standard educational approaches to the prevention and management of CINV.

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Patients in the intervention group first chose an avatar that represented a person receiving chemotherapy for the first time. Following a tutorial on approaches to CINV prevention and self-management embedded within the game, they made decisions regarding use of antiemetic medication, food and beverages, and other nonpharmacologic approaches for their avatar during a 3-day period starting at the point when the avatar leaves the treatment center. These decisions subsequently triggered algorithms that demonstrated the level of nausea experienced by the avatar.

All patients completed a written symptom-management checklist that included daily fluid intake and CINV-related preventive and self-management approaches undertaken after each cycle and week of chemotherapy treatment for a total of 4 cycles (12 weeks).

The average age of the study population was 69.71 years. Other demographic characteristics were female sex (74%), White race (86%), non-Hispanic ethnicity (89%), and educational level including some college (58%). Patient characteristics were similar across both groups.

Study findings showed the number of preventive approaches employed by the intervention group was nearly double the number of approaches used by the control group. In contrast, the control group used self-management approaches to CINV nearly twice as frequently compared with the intervention group.

Moreover, the level of acceptability for use of the interactive game was high among those patients who played the game and completed the evaluation form. 

“This study’s results, which indicate that teaching older adults to anticipate and practice how they will self-manage side effects at home is effective, should prompt nurses to rethink how they deliver education to patients,” the study authors stated.

They further noted that “using a technology-based simulation as an educational tool reinforces standard education and allows older adults to see the potential positive and negative consequences of their self-management actions in a safe environment, which may translate into more active symptom management at home.”

Disclosures: Funding for this study provided by The National Institute of Nursing Research (1R15NR015851).


Loerzel VW, Clochesy JM, Geddie PI. Using serious games to increase prevention and self-management of chemotherapy-induced nausea and vomiting in older adults with cancer. Oncol Nurs Forum. 2020;47(5):567-576. doi:10.1188/20.ONF.567-576