Project Summary
Older adults are at higher risk of toxicity and progressive severe effects related to cancer treatment.
They experience numerous side effects from cancer treatment including chemotherapy-induced
nausea and vomiting (CINV), but often undermanage it because they do not believe their actions to
self-manage CINV will be effective. Many older adults report taking anti-nausea medication only
when CINV is severe and some adopt a ‘watchful waiting” strategy as they wait for CINV to go away on
its own. This lack of self- management leads to reduced daily functioning, reduced adherence to
treatment, increased healthcare use (emergency department and hospital admissions) and cost, and
lower quality of life. There is a critical need for new strategies to assist older adults in engaging in
more active preventative and self-management behaviors at home to reduce negative outcomes. Our
team developed and tested a serious game intervention that directly addresses older adults’ erroneous
beliefs about CINV management. The eSSET-CINV intervention is a technology-based educational
simulation in which older adults learn to apply what they have previously learned about CINV self-
management strategies to an avatar who is at high risk for nausea at home after chemotherapy.
Players make decisions to prevent CINV and to self-manage it when it occurs. Our preliminary study
showed that older adults who were exposed to the eSSET-CINV intervention used twice as many
CINV preventative strategies than those who did not get the intervention. The goal of this study is to
determine the eSSET-CINV’s effectiveness at reducing CINV severity and healthcare use and
increasing functioning and quality of life. We will use a 2-group (intervention, attention control)
randomized clinical trial design. Aim 1 of this study is to examine changes in CINV severity, self-
management behaviors, functioning, QOL, cognitive representation and healthcare use within the
intervention group from baseline to completion of the study. Aim 2 is to determine efficacy of the
eSSET-CINV intervention by comparing differences in primary outcomes (CINV severity, healthcare
use) and secondary outcomes (self-management behaviors, functioning, and QOL) between groups at
each follow-up visit and completion of the study. A sample of 500 older adults will be recruited. The
intervention group will receive the eSSET-CINV at baseline, the attention control will receive it at the
end of the study. Both groups will be followed for 6 months. Our long-term goal is to develop unique,
culturally relevant serious games that allow older adults to practice making side-effect related self-
care decisions at home in a no-risk simulated environment. This research addresses the NIH research
priorities facilitating changes in cancer symptom prevention and self-management through increasing
positive health behaviors and improved health outcomes in an understudied population.
