Gamification as a Solution for Cancer-Induced Cognitive Impairment

Abstract

The overall survival rate for all cancers has increased over the past decades. 1 This has, in turn, substantially increased the amount of effort required to address the side effects of cancer therapies. Healthcare professionals should proactively adopt strategies to improve the quality of life of cancer survivors and maximize their reintegration into the community and daily work routine after recovery from cancer. A significant challenge that might decelerate or prevent the social rehabilitation of cancer survivors is cancer-induced cognitive impairment, also colloquially known as "chemobrain" or "chemofog." It has been reported that 10-40% of all cancer patients suffer from cancerinduced cognitive impairment. 2 Most importantly, several cancer patients with this complication eventually quit or change their professions; around 30% fail in their previous positions within two years after cancer therapy. 3,4 Cancer-induced cognitive impairment can be associated with the disease and its treatments such as chemotherapy, radiotherapy, hormone therapy, and novel anticancer treatments. [5][6][7][8][9] Existing evidence originating from both preclinical animal models and human trials has demonstrated that chemotherapy regimens, especially those containing anti-metabolic agents such as methotrexate, may cause long-lasting cognitive impairment. 5,10 Chemotherapy-related cognitive impairment (CRCI) encompasses a range of mild neurological impedi-

The Use of Gamification in the Self-Management of Patients With Chronic Diseases: Scoping Review

“…A literature review on AVGs in older patients with chronic diseases mentioned that AVGs helped to improve executive functions such as naming, memory, and sense of direction [42]. One neurocognitive learning application was also effective in improving the speed and accuracy of information processing in survivors of cancer with chemotherapy-related cognitive impairment, and the effects could be sustained for some time (at the end of intervention: the average score of perceived cognitive impairment was −7.47, 95% CI −10.80 to −4.13; P<.001 and 6 months later: the average score was −6.48, 95% CI −9.85 to −3.11; P=.001) [45]. In terms of improving attention and perception, gamification design combined with VR could provide users with an immersive experience with the first-person perspective of game characters [19,49].…”

“…In this review, some studies (31/70, 44%) indicated that relevant theories or concepts guided their gamification practices in the self-management of patients with chronic diseases. A total of 37 concepts or theoretical frameworks were mentioned in the included articles, most of which originated from psychology and cross-disciplinarity (n=33, 89%), such as self-determination theory [38,40,[42][43][44], flow theory [33,[45][46][47][48][49], social cognition theory [27,[50][51][52], goal-setting theory [34,43], information-motivation-behavioral technology model of behavior change [32,43], intrinsic motivation [16,53], self-efficacy [17,45], persuasion system design model [54], inhibitory control [55,56], patient-reported outcome [32], co-design approach, and participatory design [57].…”

“…For patients with cancer, gamification enhanced the connection between patients with cancer and others through human-computer interaction and social mechanisms [29,32,34,45,51], providing support from health care professionals, relatives, and friends. The progress bar element was applied to record their health condition, self-management measures, and psychological progress [28,34,62], giving users a sense of disease control.…”

“…AVGs come with the effect of cognitive function training. This is because the user learns the rules of the game and processes them quickly and accurately in the game, which keeps the brain active to avoid cognitive decline [45] and improves cognitive control and attention [42]. The time-limited game design element was used to train attention and goal-oriented behavior in obese patients, control the frequency of their consumption of a high-carbohydrate diet (eg, dessert), and strengthen their adherence to a healthy diet [55,56].…”

“…On the basis of neuroplasticity, rehabilitation of cognitive impairment is possible for survivors after cancer chemotherapy or stroke [19,45,53,86]. A literature review on AVGs in older patients with chronic diseases mentioned that AVGs helped to improve executive functions such as naming, memory, and sense of direction [42].…”