The healing power of video games

"When you walk into a room and someone is feeling physically really low," says Cion, "they might be vomiting and they might be in a lot of pain, and to engage them creatively has a real effect. ... You can in a short period of time have somebody stop crying, start focusing on a project and start laughing and telling stories."

There's a biological, physiological value to being focused like this, he argues. "You're releasing endorphins; there are certain pain inhibitors that are getting blocked when you're focusing. And all of a sudden you're engaged with something and you literally see the life coming back to people. You see [their] dynamic steer to spunky — you know, fun shine[s] forth in somebody when they start to engage in something creative."

Cion gets sick kids into things like painting and animating. He helps them create something incredible that will be showcased publicly — often in the form of a digital remix that brings their original drawing to life. But his reach is limited; he is able to see and build meaningful relationships with barely 15 to 20 percent of the 2,000 or so children with cancer that MD Anderson treats each year. And for all the good it does, his program is costly. "To get my position in place," he says, "we had to start a pilot program, get grant funding, work and really document everything that we're doing, do tons of presentations within the institution and beyond and continually raise money — just to keep me going."

Gonzalez had already completed his treatment by the time Cion started, but the pair have worked together on a number of projects. Gonzalez did an animation internship while he was still in high school. He was tasked with developing animated versions of patient artwork. It was one of many initiatives meant to foster a sense of community and to support patients and families going through treatment.

"I think in terms of self image and body image, there are people going through a lot of changes," Cion says, "and they don't necessarily want their friends and families to see them when they are physically down with their hair falling out or skin much more frail.

"In some ways the digital world, the virtual world, the gaming world — all these platforms for connecting where you're not necessarily representing yourself physically can be helpful because [they allow] people to stay connected in a lot of ways where they might be a bit shy."

He'd love to have another five or six artists to work alongside him permanently, to better refine this idea, but the reality is that budgets only stretch so far — and in many cases other services or new equipment like MRI machines take precedence. Meanwhile, the patients at MD Anderson who don't get to work with Cion still have access to a team of child life specialists and a number of dedicated play rooms, including an arcade where teenagers can hang out and play games both new and old. And the hospital has renovated since Gonzalez was a patient, further improving the quality of life during treatment for patients and their families.

MD Anderson is also collaborating with Houston-based developer Playnormous on a number of health-related games and apps, with Gonzalez and other patients consulting on the designs alongside doctors and nutritionists.

"The good news is that I've kind of been preparing for this all my life without even realizing it," says Gonzalez-Novoa. His last job was executive director at a non-profit leadership development organization. He was originally trained in play therapy — a kind of counseling and psychotherapy that encourages children to express their thoughts and feelings and process traumatic experiences with help from toys, games and art materials. His focus was on what he describes as "the healing power of play for pre-school children." He moved to New York in 1997 to work on a startup, then ran after-school programs for teenagers — some of whom were HIV positive.

"Getting adolescents to get support around very sensitive health issues when they already have lots of stuff going on in their life as a teenager is really hard," he says. "We've made strides in social media and technology, but teenagers are still teenagers."

That's both challenging and wonderful, he argues, and games may prove the best way to reach them. Researchers have had positive results with games specifically targeted at educating teen cancer patients about their illnesses and the consequences of not taking prescribed medicine.

HopeLab's third-person shooter Re-Mission is one such game, taking players on a wild tour through the immune system of a cancer patient as they blast the bad cells into oblivion. It took a team of animators, cell biologists, cancer experts, psychologists and cancer patients six years to create, and now a follow-up collection of six arcade-style minigames — which Steven Gonzalez consulted on — is playable online.

Patient Empowerment, a collaborative effort between the University of Utah and the Utah Primary Children's Medical Center in 2011, similarly encourages healing — its inspiration came from the observation that an incentive spirometer is a very simple game that motivates patients to do better. The idea is that the character in the game will inspire players to fight their diseases and maintain their treatments as well as carry the attitude that nothing is insurmountable into every facet of life.

A growing body of research indicates that playing games reduces nausea and anxiety in people of all ages. Games are increasingly used to treat soldiers with post-traumatic stress. Additionally, Nintendo Wii games have been shown to help senior citizens stay more active and socially connected, staving off the ravages of aging.

The Nintendo Wii was also used effectively to promote physical activity and lift the spirits of adult hospital patients with cancer. "All patients lost time awareness and felt distracted from the daily hospital routine," wrote University Hospital Halle's head of nursing research and development, Patrick Jahn in a journal article for Oncology Nursing Forum. "A majority of patients [also] reported an improved mood state from the game sessions."

Charities such as Child's Play, Extra Life and GamesAid raise millions of dollars in donations each year to provide game consoles, games, toys and a variety of services to sick kids and hospitals around the world. They receive heart-rending testimonials that show that even if games can't cure cancer, they can at least pose a very real therapeutic effect.

Now Gonzalez and his uncle hope to tie it all together — games, cancer, community, teenagers and play therapy. They're building relationships with hospitals, game developers and sick kids, learning what works, what's already out there and what's missing. Their goal is to plug all the gaps, and to make socializing over video games easier for these kids. The Survivor Games is planning an initial test of its social network this spring, with an online arcade rolling out some time after that, which will offer a number of games that are downloadable or playable in a web browser.

The arcade will be built around what they term "survivor games" — games that are fun to play, are largely social and involve cooperation. Not every game is suited to the needs of cancer patients — blood and death can raise stress levels, while many of the more immersive 3D experiences cause nausea, and at various phases of treatment, physically demanding titles may be too much to handle.

Survivor games tend to be more constructive like Minecraft, Gonzalez-Novoa says, and they generally offer more of a blank slate kind of playable character — somebody who players can easily project themselves onto and who will grow in power and skill as the game progresses. "Those days where you feel like you're losing to cancer but you can beat something else," he says, "it gives you that motivation like, 'If I can beat a 14-foot monster in a game then cancer is nothing.'"

They are trying to work with indie developers, who Gonzalez-Novoa believes are best prepared to respond to these needs, with the hope that existing games and game ideas can be adapted somehow. "[Like] this is a great game that kids love," he says, "but ... can we reimagine it as a multiplayer game? Because it's reinforcing their sense of isolation."

It's too early to tell how The Survivor Games and its ideas will be received in medical circles beyond the child life specialists who use play to engage kids every day. But its founder is hopeful. "Everyone that we've talked to so far is really open-minded about doing things differently — approaching situations differently," says Gonzalez. "Even if they don't pick it up right away, they're really open-minded to picking it up. So with some explanation, and just telling my story, they eventually see it. It's really cool to watch it unfold."