Doctors can’t inject cancer patients with intelligent nanobots programmed to launch surgical counterstrikes against the disease. That didn’t stop a team of medical researchers and software programmers from developing a video game several years ago that helped young patients imagine such an empowering scenario. Based on the success of that project, the team recently launched a sequel geared for mobile devices that they hope will further encourage kids undergoing chemotherapy and other treatments to better understand what’s happening inside their bodies and how they might regain their health.

Re-Mission 2 is a collection of six free online games—accessible via Web browser or Apple iPad—that share the theme of taking the fight to cancer. They do this by arming patients with a virtual arsenal of chemo, radiation and targeted cancer drug attacks designed to crush advancing malignant forces. The game—and its 2006 predecessor Re-Mission—are the product of HopeLab, a nonprofit founded in 2001 by Pamela Omidyar, wife of eBay founder Pierre Omidyar.

It’s hard to deny that a diversion such as “Stem Cell Defender,” in which players protect white blood cells from a bacteria invasion by unleashing antibiotic bombs, could do wonders for a child’s morale during long waits at a doctor’s office or hospital. (Bacterial infections, nausea and constipation are some treatment-related effects patients may experience.) HopeLab, however, insists the games do more even more than this, claiming they improve treatment outcomes by educating young patients about the disease and how it can be fought. Such knowledge makes these patients more likely to adhere closely to their treatment regimens.

HopeLab has backed this claim over the past few years with a number of studies, although the organization is careful not to directly associate game play with actual cancer remission. In the most recent study, HopeLab worked with Stanford University associate professor of psychology and neuroscience Brian Knutson on a functional magnetic resonance imaging (fMRI) study analyzing brain regions activated when people play the original Re-Mission. The paper, published in the March 2012 PLoS ONE, compared brain scans in 57 cancer-free undergraduates who were randomly assigned to actively play Re-Mission or passively watch the game. Re-Mission players experienced more activity in neural circuits associated with incentive motivation when compared to those who merely observed game play. Such reward-related activation could shift attitudes and emotions and boost players’ adherence to prescribed chemotherapy and antibiotic treatments to fight infection, the researchers said, although they acknowledge that further tests are needed on actual cancer patients before they can read too much into the results.

An earlier study published in the journal Pediatrics in August 2008 (pdf) sought to determine whether video games could encourage adolescent and young-adult cancer patients to more consistently take self-administered treatments such as oral chemotherapy, a particularly difficult problem in that age group. The study—which included 374 adolescents and young adults with malignancies including acute leukemia, lymphoma, and soft-tissue sarcoma—found that those who played Re-Mission took their medication more consistently, increased their knowledge of the disease and generally played a more active role in their treatment (pdf). Although that study was led by principal investigator and former HopeLab president and CEO Pamela Kato, it also included researchers from West Virginia University and the University of Texas Health Science Center.

Re-Mission 2 caters to kids who have grown up playing Angry Birds, Fruit Ninja and other games on the Internet or via apps on their mobile devices. In fact, the sequel can be played only online or on the iPad. HopeLab is working on versions that will work on Android devices. This is a calculated switch from the format of the original version of Re-Mission, which took players on a quest heavily influenced by popular video games at the time, most notably Tomb Raider. Instead of Lara Croft, Re-Mission featured a microscopic robot named Roxxi, clad in form-fitting silver body armor, who traveled through the bodies of fictional cancer patients, blasting cancer cells and battling the side-effects of cancer and its treatments.

The Re-Mission re-boot is a welcome change, says Brooke Jaffe, a 21-year-old junior at Barnard College in New York City. Quest games like Tomb Raider that are played on PCs and video game consoles like Xbox or the Wii can be intimidating to people who don’t already play them, adds Jaffe, an English major who became aware of HopeLab’s work after she was successfully treated for papillary carcinoma—thyroid cancer—in 2011.

Re-Mission 2 is a much more casual approach to gaming. It may not have the complicated 3-D graphics and the emphasis on anatomical realism of its predecessor, but it’s certainly more accessible to a kid waiting to undergo treatment, or who is fatigued from having just undergone treatment, says Jaffe, one of 120 teens and young adults HopeLab recruited to help develop and evaluate Re-Mission 2. The idea is that patients will get a lot more enjoyment from playing 10 minutes of one of Re-Mission 2’s simpler games than they would from 10 minutes of the original version, which might require 30 minutes of play to get past the first level.

Images courtesy of HopeLab