title: Adapting a Videogame to the Needs of Pediatric Cancer Patients and Survivors.
abstract: OBJECTIVE
  This study assessed whether two serious videogames, "Escape from Diab" (Diab) and "Nanoswarm: Invasion from Inner Space" (Nano) (both from Archimage, Inc., Houston, TX) shown to effect change in healthy children's diet and possibly physical activity are acceptable for obesity prevention among pediatric cancer patients and survivors at high risk of obesity.
  
  
  METHODS
  Pediatric (9-12-year-old) cancer patients and survivors (n=28) were randomly assigned to one of three groups: Group A, watched film adaptations of both game stories and played the first two episodes of each game; Group B, played all of Diab; or Group C, played all of Nano. Qualitative interviews about what the children liked and didn't like and what should be changed were conducted midway and at the end of each group's participation. Data were analyzed using thematic analysis.
  
  
  RESULTS
  Pediatric cancer patients and survivors enjoyed playing both games. Two themes emerged to guide future modifications of the game: Three patients reported difficulty with the energy balance and meal selection portion of Nano, and four patients stated endings showing a character dying made them sad.
  
  
  CONCLUSIONS
  Two serious videogames designed to promote healthier diet and increased physical activity among healthy children were also found to be acceptable by pediatric cancer patients and survivors. Easier options needed to be programmed into energy balance games in Nano. To avoid possible emotional reactions, such as sadness, Nano's ending will be revised so that a character does not die from his affliction. Minor changes will be made in other gameplay mechanics and storylines to meet target audience needs and preferences.
authors.affiliation: 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas.
authors.forename: Alicia
authors.initials: A
authors.lastname: Beltran
authors.affiliation: 2 Pediatrics Research, Children's Cancer Hospital, University of Texas M.D. Anderson Cancer Center , Houston, Texas.
authors.forename: Rhea
authors.initials: R
authors.lastname: Li
authors.affiliation: 3 Division of Pediatrics, Children's Cancer Hospital, University of Texas M.D. Anderson Cancer Center , Houston, Texas.
authors.forename: Joann
authors.initials: J
authors.lastname: Ater
authors.affiliation: 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas.
authors.forename: Janice
authors.initials: J
authors.lastname: Baranowski
authors.affiliation: 4 Archimage, Houston , Texas.
authors.forename: Richard
authors.initials: R
authors.lastname: Buday
authors.affiliation: 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas.
authors.forename: Debbe
authors.initials: D
authors.lastname: Thompson
authors.affiliation: 5 The University of Texas Graduate School of Biomedical Sciences at Houston , Houston, Texas.
authors.forename: Joya
authors.initials: J
authors.lastname: Chandra
authors.affiliation: 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas.
authors.forename: Tom
authors.initials: T
authors.lastname: Baranowski