Imagine you’re heading home from chemotherapy treatment armed with information from doctors and nurses on how to manage the most feared side effects: nausea and vomiting. What do you do?

If you’re an older adult, you may do nothing. That’s not good, according to Victoria Loerzel ’07PhD, a professor in UCF’s College of Nursing who has been researching older adults with cancer for over a decade.

This is why Loerzel and a team of researchers developed an innovative educational game for older adults with cancer. The game recently received a $2.5 million grant from the National Institutes of Health National Institute of Nursing Research for a large-scale pilot.

Compared to their younger counterparts, adults ages 65 and older are at higher risk for severe side effects from chemotherapy, according to research from the journal Drugs & Aging. The nausea and vomiting can lead to dehydration, toxicity and additional hospitalizations, all negatively impacting daily activities and quality of life.

“Older adults tend to think that their actions to self-manage at home won’t work, so they develop a ‘wait and see’ strategy that can result in these negative side effects and outcomes,” says Loerzel.

That’s where the game comes in.

Simulated Symptoms

The educational-based game simulates life at home for older adults after chemotherapy treatment and applies to any cancer.

“It doesn’t matter what type of cancer you have. Your beliefs about how to manage it, and how you manage it, is consistent,” says Loerzel.

Patients make decisions for an older avatar, inspired by Loerzel’s parents, to prevent nausea and vomiting and decide what to do when it does occur.

“It’s putting themselves in the avatar’s shoes, making decisions for them and seeing the outcomes of those decisions,” she says.

The tablet-based game, which takes only 10 minutes to 15 minutes to complete, simulates a three-day period with different times of day and events. With chemotherapy, patients take medications, drink lots of fluids, and avoid specific foods, including spicy ones, to minimize the side effects of nausea and vomiting. These are lessons that the game reinforces.

A small preliminary study was successful; older adults who used the intervention used twice as many preventative strategies than those who did not play the game.

“Those who played the game were proactive and didn’t have as much nausea as they could have, while the control group waited until they started to feel sick before they did anything,” says Loerzel.

Early patient feedback was also positive, with older adults saying it was easy to use and helpful. The new research funding will support a five-year, multi-site study to test the game with 500 older adults. The study will follow the participants for up to six months to determine its effectiveness in reducing symptom severity, hospital admissions and improving quality of life.

The research addresses a critical national need to develop new strategies to improve health outcomes for older adults with cancer.

The need for the game became more apparent and personal last year for Loerzel when her mother was diagnosed with breast cancer and played the game using her own avatar.

The experience with her mom, who is in remission, gave Loerzel a greater understanding of life at home for these patients and their families. “Education can help a lot, but you don’t know what someone will do until they go through it. It is why I want to prepare people the best that we can.”

Cancer and Aging Insights

An oncology nurse for more than two decades, Loerzel began to focus her research on older adults with cancer during her doctoral dissertation at UCF. At that time, most of the research looking at quality of life for people with cancer was based on the average age of 50. “But 50 is very different from 70 or 80,” she says, based on her firsthand experiences as a nurse. “That began my interest in this age group and how they manage symptoms, which is oftentimes not at all.”

Her research is much needed. According to the National Cancer Institute, half of cancer cases occur in people ages 66 and older, which is a growing population in the U.S. and the State of Florida.

She was the first nurse researcher to identify misperceptions of how older adults manage symptoms at home, and with this innovative intervention, she’s created a model for serious gaming in older adults that demonstrates the benefits of using technology in patient education.

For Loerzel, the goal is simple. “I want to make the experience for older adults with cancer a little bit better,” she says. “I want them to feel good and live as normal a life as they can throughout cancer treatment.”