At an age when most kids start school and learn to ride bikes, Nico Poux was fighting for his life. Diagnosed with leukemia at age 6, Poux has battled cancer the bulk of his life.
"What I remember is a lot of time spent in the hospital," Poux, now 15, recalled. While in the hospital, he played and helped develop a video game designed specifically for childhood cancer patients, aptly called "Re-Mission." The game was developed by HopeLab, a California-based nonprofit founded in 2001 whose goal is to pair technology and research with innovative health solutions.
Kids playing "Re-Mission" learn how important their treatment is through the game, in which the player blasts cancer cells with a chemo gun — equipped with different drugs that kids can choose depending on their treatment plan. Poux said the game empowered him when he felt helpless.
"Boredom just makes you feel more terrible about the situation," Poux said. "If you're distracted, it takes away some of the mental effort."
That's exactly what the game is designed to do, says Richard Tate of HopeLab.
"The game makes them feel powerful and capable," Tate said. "The challenge is not that we don't have effective treatments. The challenge is getting them to adhere to treatment."
"Re-Mission" is just one example of how video games and the technology behind them are changing the landscape of cancer treatment. While playing games can help kids like Poux learn and understand their illness, related technology may also someday help those same kids beat cancer dramatically faster.
Seeing cancer more clearly
Medical engineer and physicist Dr. Steven Jiang doesn't play video games, but he and his team at the University of Texas Southwestern Medical Center certainly respect the technology.
Jiang and his team use the same 3D graphics processing units, or GPUs, that millions of gamers put into their PCs to make the battlefields of "Call of Duty" more realistic — but Jiang uses them to make different images come into sharper focus: cancer cells.
"The computer on your desk is as powerful as the best supercomputer five years ago," Jiang said.
To explain how GPUs improve chemotherapy, Jiang described the current process of oncology: A patient is diagnosed and an individualized radiation dose is calculated based on a variety of factors, including the size of the cancer growth. This process can take days or weeks, with hospitals using multiple computers.
"For one patient, calculating an individual treatment can take about 70 hours if you use a conventional computer. I've seen hospitals that use 30 computers together and it still takes a few hours," Jiang said. "Now, we can do it in seconds or minutes."
That means, Jiang says, that eventually hospitals could treat patients the same day they are diagnosed and update the treatment by imaging the cells after treatment, which means less damage to surrounding healthy tissue if a growth shrinks.
"Right now, we have no way to update a treatment plan. We don't have time to do that. To make an individual treatment plan, you have to know a lot about (a cancerous cell or growth)," Jiang said. "Now we can do all the planning in seconds instead of hours or days, and then develop a new treatment plan based on the geometry from that day."
It's easy to see how this kind of time-saving technology could save lives. Poux, who was diagnosed as a young child, relapsed several times over the course of his childhood and was often confined to his bed during a lengthy treatment process. Yet the implications of the technology go beyond how cancer is treated to how it could be prevented.
"We could use this technology to create new imaging techniques that require much less radiation," Jiang said. "No matter what, we've got to reduce the amount of radiation used in imaging."
Research suggests that medical imaging like CT scans may be contributing to many cancer diagnoses and deaths. A New York Times article from last winter examined a study from the National Cancer Institute that found a connection between cancer and exposure to radiation in routine imaging like CT scans. As the Times cited, one in 10 Americans has a CT scan every year, but many people have several.
NCI estimated that CT scans conducted in 2007 will cause a projected 29,000 excess cancer cases and 14,500 excess deaths over the lifetime of medical imaging patients. The Times extrapolated that estimate to claim that "unless we change our current practices, 3 percent to 5 percent of all future cancers may result from exposure to medical imaging."
While more research is needed, the solution could lie in video game technology originally developed for entertainment, Jiang said, and for little extra expense — the GPUs used in his research cost about $500 at any given BestBuy.
Play for recovery
A few years ago, child life specialist Jacob Lore walked into a waiting room at Stanford's Lucile Packard Children's Hospital and realized there was a new sheriff in town: Angry Birds. It's Lore's job to explain cancer treatment to small children in terms they can understand — but all Lore had that day was a felt board.
"It was hard to compete with Angry Birds and hold their attention," Lore said. "'Re-Mission' gives kids a way to learn about their condition while having fun. If they're not aware of what's going on and they're forced to do everything, why would they do it?"
"Re-Mission" also offers sick kids something that is not to be overlooked, Lore said: play.
"Play is like a kid's work. No matter what, kids are going to play. We can't take that away from them," Lore said.
But "Re-Mission" is much more than educational or mere fun. HopeLab's research has found that the benefit of the distraction and stress relief the game provides contributes to a child's recovery by boosting confidence and resilience. In a study HopeLab published in 2008, kids who played the game had a better picture of how their treatment worked for them and were more likely to adhere to a treatment regimen.
Tate says HopeLab is conducting further research that will hopefully identify biological markers, which will tell researchers specifically how the brain's reaction to game play impacts recovery.
Resilience is something Poux has in spades. Today, he's already a high school junior and is shopping around for colleges. With doctors and family confident he's in remission for good, Poux is looking toward a bright future.
"Since I have all this experience," Poux said, "I'm leaning toward (studying) medicine."