Game-Based App Helps Children Self-report Symptoms During Cancer Treatment

By utilizing a gamified mobile health (mHealth) app, children with cancer are able to self-report symptoms and daily experiences during their cancer treatment, according to research published in Journal of Pediatric Nursing.

The app, Color Me Healthy, is a game-based digital therapeutic codesigned by pediatric oncologists, game design students and faculty, and children with cancer to assess childrens' symptoms during treatment.

Some of the gamified elements include a customizable avatar, diary, sketch pad, and daily goals checklist. Additionally, children can report their general and localized symptoms by clicking or drawing on their avatar or by using a sliding bar to report symptom severity.

Eight common cancer-related symptoms were derived from the Memorial Symptom Assessment Scale and interviews during app development, and these are pain, fatigue, nausea, vomiting, difficulty sleeping, decreased appetite, cough, and dizziness. Localized symptom options include mouth sores, bruising, and numbness or a tingling sensation in areas such as the head, mouth, chest, abdomen, and extremities.

The app’s language is also designed for children, with simple tasks like brushing teeth or going for a walk and using the word bother rather than distress when reporting symptom severity.

According to the study authors, the app was also designed to learn about children’s engagement in usual childhood experiences, not just to focus on how cancer affects their lives.

The study included 19 children aged 6 to 12 years—with a median age of 8 years and most (12) being boys—who were receiving cancer treatment at the Center for Cancer and Blood Disorders at a free-standing pediatric hospital in the Intermountain West region of the United States. Cancer diagnoses included acute lymphoblastic leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, osteosarcoma, and brain tumor.

The group was advised to use the Color Me Healthy app for at least 5 days between clinical visits, which varied between patients and ranged from 5 days to 4 weeks between visits. Data from 107 days of app use were collected.

Every child in the study reported symptoms in the app at least once during the study, with 14 children reporting a symptom of moderate or greater severity at least once. They were also able to free-write short comments alongside their symptoms, which can help physicians better understand exactly how a pediatric patient feels. Twelve children used this feature to provide qualitative reports of symptoms.

“Simple open-ended questions can be used as potential screening tools to gain insight into children’s physical and psychosocial functioning and well-being,” the authors said. “Questions such as ‘What is the best thing about today?’ and ‘What is bothering you the most today?’ are not limited to inclusion in an app but can be easily incorporated into clinical conversations.”

In terms of adherence, the median number of days of overall app use was 4 (range, 1-12). It was not clear to the authors why some children used the app more than others or why they didn’t report symptoms on certain days.

Due to the short time frame of the study, limited sample diversity, and limited or missing data collected from the mobile app, additional research is needed to fully understand the clinical utility of Color Me Healthy and similar mHealth apps, the authors noted.

However, they added, these findings serve as preliminary evidence of the potential benefits and clinical relevance of mHealth resources for younger patients.

Reference

Linder LA, Newman A, Bernier Carney KM, et al. Symptoms and daily experiences reported by children with cancer using a game-based app. J Pediatr Nurs. Published online April 28, 2022. doi:10.1016/j.pedn.2022.04.013