Serious games: a game changer in cancer education

Abstract

The enormous global burden of cancer has created the need to develop cutting-edge strategies for enhancing public education on cancer. Over the years, conventional educational strategies, such as the use of posters and leaflets, have been preferentially employed as public education strategies on oral cancer; however, the use of digital education-based strategies has been largely underutilized. Notably, the use of digital education-based strategies, particularly serious games, has proven to be a superior cancer education strategy, when compared to conventional strategies, due to their rigorous design and features. This commentary discusses serious games as a game changer in cancer education, itemizing their diverse roles in cancer prevention, advocacy, and management. Also, this commentary also detailed those factors that might limit the use and availability of serious games in resource-limited settings.

Keywords

Cancer / education / games / gamification / intervention / public health

References

[1] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71:209-49.

[2] Lombe DC, Mwamba M, Msadabwe S, Bond V, Simwinga M, Ssemata AS, et al. Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review. BMJ Open. 2023; 13:e067715.

[3] Shao Y, Hu H, Liang Y, Hong Y, Yu Y, Liu C, et al. Health literacy interventions among patients with chronic diseases: A meta-analysis of randomized controlled trials. Patient Educ Couns. 2023; 114:107829.

[4] Wouters P, van Nimwegen C, van Oostendorp H, van der Spek ED. A meta-analysis of the cognitive and motivational effects of serious games. J Educ Psychol. 2013; 105:249-65.

[5] Kim S, Wilson P, Abraham O. Investigating the Use of Serious Games for Cancer Control Among Children and Adolescents: Scoping Review. JMIR Serious Games. 2024; 12:e58724.

[6] 45+ Out of this world video games industry statistics in 2024 [Internet].TechJury.net; [cited 2025 Apr 5]. Available from:https://techjury.net/blog/video-games-industry-statistics

[7] Distribution of serious games in the United States in 2021, by age group [Internet].Statista; [cited 2025 Apr 5]. Available from:https://www.statista.com/statistics/189582/age-of-us-video-game-players

[8] Tong JWA, Hee MQ. The impact of an online educational game on breast cancer awareness among university female students, Malaysia: a pilot study. BMC Cancer. 2023; 23:947.

[9] Krath J, Schürmann L, von Korflesch HFO. Revealing the Theoretical Basis of Gamification: A Systematic Review and Analysis of Theory in Research on Gamification, Serious Games and Game-Based Learning. Comput Hum Behav. 2021; 125:106963.

[10] De Gloria A, Bellotti F, Berta R, Lavagnino E. Serious Games for education and training. Int J Serious Games. 2014:1.

[11] Wattanasoontorn V, Boada I, Hernandez R, Sbert M. Serious games for health. Entertain Comput. 2013; 4:231-47.

[12] Craig S, Stark P, Wilson CB, Carter G, Clarke S, Mitchell G. Evaluation of a dementia awareness game for undergraduate nursing students in Northern Ireland: a Pre-/Post-Test study. BMC Nurs. 2023; 22:177.

[13] Mun Y, Oprins E, van den Bosch K, van der Hulst A, Schraagen JM. Serious Gaming for Adaptive Decision Making of Military Personnel. Proc Hum Factors Ergon Soc Annu Meet. 2017; 61:1168-72.

[14] Damaševičius R, Maskeliūnas R, Blažauskas T. Serious Games and Gamification in Healthcare: A Meta-Review. Information (Basel). 2023; 14:105.

[15] Beranič T, Heričko M. The Impact of Serious Games in Economic and Business Education: A Case of ERP Business Simulation. Sustainability (Basel). 2022; 14:683.

[16] Khalil GE, Beale IL, Chen M, Prokhorov AV. A Video Game Promoting Cancer Risk Perception and Information Seeking Behavior Among Young-Adult College Students: A Randomized Controlled Trial. JMIR Serious Games. 2016; 4:e13.

[17] Carcioppolo N, Kim S, Sanchez M, Mao B, Malova E, Ryan A, et al. Evaluating a game-based randomized experiment to increase melanoma identification among adults living in the U.S. Soc Sci Med. 2022; 310:115281.

[18] Cancer prevention and control in the context of an integrated approach [Internet]. World Health Organization; [cited 2024 Dec 10]. Available from:https://apps.who.int/gb/ebwha/pdf_files/EB140/B140_31-en.pdf

[19] Lopez AM, Hudson L, Vanderford NL, Vanderpool R, Griggs J, Schonberg M. Epidemiology and Implementation of Cancer Prevention in Disparate Populations and Settings. Am Soc Clin Oncol Educ Book. 2019; 39:50-60.

[20] Smith SA, Blumenthal DS. Efficacy to effectiveness transition of an Educational Program to Increase Colorectal Cancer Screening (EPICS): study protocol of a cluster randomized controlled trial. Implement Sci. 2013; 8:86.

[21] Lana A, Faya-Ornia G, López ML. Impact of a web-based intervention supplemented with text messages to improve cancer prevention behaviors among adolescents: results from a randomized controlled trial. Prev Med. 2014; 59:54-9.

[22] Ribeiro N, Tavares P, Ferreira C, Coelho A. Melanoma prevention using an augmented reality-based serious game. Patient Educ Couns. 2024; 123:108226.

[23] Ferwerda B, Lee MJ. Tamagotchi++: A serious, personalized game to encourage healthy behavior. In Joint Proceedings of the ACM IUI 2019 Workshops; 2019 Mar 20; Los Angeles, USA.

[24] Kim HJ, Kim SM, Shin H, Jang J, Kim YI, Han DH. A Mobile Game for Patients With Breast Cancer for Chemotherapy Self-Management and Quality-of-Life Improvement: Randomized Controlled Trial. J Med Internet Res. 2018; 20:e273.

[25] Anderson T, Prue G, McDowell G, Stark P, Wilson CB, Wisener LG, et al. Co-design and evaluation of a digital serious game to promote public awareness about pancreatic cancer. BMC Public Health. 2024; 24:570.

[26] Reichlin L, Mani N, McArthur K, Harris AM, Rajan N, Dacso CC. Assessing the acceptability and usability of an interactive serious game in aiding treatment decisions for patients with localized prostate cancer. J Med Internet Res. 2011; 13:e4.

[27] Poliani A, Gnecchi S, Villa G, Rosa D, Manara DF. Gamification as an Educational Approach for Oncological Patients: A Systematic Scoping Review. Healthcare (Basel). 2023; 11:3116.

[28] Thomas TH, McLaughlin M, Hayden M, Shumaker E, Trybus J, Myers E, et al. Teaching Patients with Advanced Cancer to Self-Advocate: Development and Acceptability of the Strong Together™ Serious Game. Games Health J. 2019; 8:55-63.

[29] Kondylakis H, Bucur A, Crico C, Dong F, Graf N, Hoffman S, et al. Patient empowerment for cancer patients through a novel ICT infrastructure. J Biomed Inform. 2020; 101:103342.

[30] Kato PM, Cole SW, Bradlyn AS, Pollock BH. A video game improves behavioral outcomes in adolescents and young adults with cancer: a randomized trial. Pediatrics. 2008; 122:e305-17.

[31] Quintana Y, McWhirter J. Culturally appropriate behavioral change in maternal health: role of mobile and online technologies over time. In: Patel V, Arocha J, Ancker J, editors. Cognitive Informatics in Health and Biomedicine. Health Informatics. Cham: Springer; 2017. pp. 217-33.

[32] Rodgers WM, Christina CL. The role of motivation in behavior change: how do we encourage our clients to be active? ACSM Health Fit J. 2009; 13:7-12.

[33] 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; 47:567-76.

[34] Kim SM, Kim H, Hwang HC, Hong JS, Bae S, Min KJ, et al. The Effects of a Serious Game on Depressive Symptoms and Anxiety in Breast Cancer Patients with Depression: A Pilot Study Using Functional Magnetic Resonance Imaging. Games Health J. 2018; 7:409-17.

[35] Loerzel VW. Symptom Self-Management: Strategies Used by Older Adults Receiving Treatment for Cancer. Clin J Oncol Nurs. 2018; 22:83-90.

[36] Hafeez M. Effects of game-based learning in comparison to traditional learning to provide an effective learning environment-A comparative Review. Contemp Educ Res J. 2021; 8:89-105.

[37] Purnama WG, Maulidevi NU, Suwardi IS. Challenges and Opportunities in Serious Game for Learning Authority Tool. Int J Innov Technol Explor Eng. 2019; 8:227-32.

[38] Klemke R, van Rosmalen P, Ternier S, Westera W. Keep It Simple: Lowering the Barrier for Authoring Serious Games. Simul Gaming. 2015; 46:40-67.

[39] Arora C, Razavian M. Ethics of Gamification in Health and Fitness-Tracking. Int J Environ Res Public Health. 2021; 18:11052.

[40] Warsinsky S, Schmidt-Kraepelin M, Rank S, Thiebes S, Sunyaev A. Conceptual Ambiguity Surrounding Gamification and Serious Games in Health Care: Literature Review and Development of Game-Based Intervention Reporting Guidelines (GAMING). J Med Internet Res. 2021; 23:e30390.

[41] Ayed I, Ghazel A, Jaume-I-Capó A, Moyà-Alcover G, Varona J, Martínez-Bueso P. Vision-based serious games and virtual reality systems for motor rehabilitation: A review geared toward a research methodology. Int J Med Inform. 2019; 131:103909.

[42] Mubin O, Alnajjar F, Mahmud AA, Jishtu N, Alsinglawi B. Exploring serious games for stroke rehabilitation: a scoping review. Disabil Rehabil Assist Technol. 2022; 17:159-65.

[43] Doumas I, Everard G, Dehem S, Lejeune T. Serious games for upper limb rehabilitation after stroke: a meta-analysis. J Neuroeng Rehabil. 2021; 18:100.