Survivors of Childhood CancerWINNERSNCT06312969
Technological Gaming in Cancer Survivors (WINNERS)
A study testing Video game based training in people with Survivors of Childhood Cancer, run by Antonio Pérez Martínez at 1 site in Spain.
Trial summary
HYPOTHESIS 1. Neurocognitive deficits in cancer survivors are underestimated. They represent a very limiting long-term side effect in this group of patients. 2. An individualized, planned and limited intervention using technological gaming can improve neurocognitive function in these pediatric patients by taking… Read more about this study
- Who is it for?
- Ages 8 to 17 yearsHealthy volunteers can take part
- Conditions the study is for
- Survivors of Childhood Cancer
- What is being tested?
- Video game based training
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 56 participants
- Where
- 1 siteSpain
- Study dates
- 23 Feb 2023to Feb 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 8 to 17 years
- All sexes
- Healthy volunteers accepted
- Child
Who may be able to join
- Patients between 8 and 17 years of age at the time of recruitment.
- Have completed treatment between 1 and 6 years prior to recruitment.
- Have had one of the following diagnoses:
- Patients with CNS disease (posterior fossa tumors and supratentorial gliomas smaller than 1 cm affecting associative areas).
- Patients with hematologic malignancies (leukemia or lymphoma).
- Patients with solid tumors.
Show all 14Show fewer
- Patients with non-malignant hematological diseases and indication for allogeneic hematopoietic progenitor transplantation.
- Having received at least one of the following treatments:
- Central nervous system surgery.
- Central nervous system radiotherapy.
- Intrathecal/intraventricular chemotherapy.
- Neurotoxic systemic chemotherapy.
- Hematopoietic stem cell transplantation.
- Informed consent signed by parent/guardian.
Who cannot join
- Active oncologic disease or relapse of active oncologic disease.
- Prior neurological or psychiatric pathology that may preclude trial or treatment evaluations:
- Psychological or neurocognitive illness or sequelae that preclude neuropsychological assessment or are expected to significantly artifact MRI results (examples: significant decrease in visual acuity, CNS surgical scar that artifacts imaging results, severe cognitive delay that precludes testing, etc.).
- Psychological or neurocognitive illnesses or sequelae that prevent or contraindicate the use of video games (epilepsy that prevents the use of screens, significant decrease in visual acuity, etc.).
- Mild or self-limiting neurological or psychiatric pathology that does not interfere with trial diagnosis and treatment (headache, epilepsy in remission with effective treatment, mild cognitive delay, etc.) will be allowed.
- Current or recent (less than 1 year) use of other cognitive stimulation or brain training that may interfere with study results.
- Refusal to abstain from the use of the study treatment games in case of being assigned to group B (control group).
- Medical treatment that may significantly interfere with neuropsychological, imaging or biomarker assessments.
Trial locations and contacts
1 site in 1 country.
Spain1 site, 1 recruiting
- Recruiting
Hospital La Paz
Madrid, 28046
Carlos Gonzalez-Perez, MD, 0034917277223, carlos.gonzalez2@salud.madrid.org
Antonio Perez-Martinez, PhD, MD
About this study
Official title: Cognitive Training Through Technological Gaming To Ameliorate Cognitive Effects Related To Childhood Cancer Treatment (WINNERS)
HYPOTHESIS
- Neurocognitive deficits in cancer survivors are underestimated. They represent a very limiting long-term side effect in this group of patients.
- An individualized, planned and limited intervention using technological gaming can improve neurocognitive function in these pediatric patients by taking advantage of the plasticity of the central nervous system (CNS) in the pediatric age.
- Changes can be demonstrated not only at the cognitive level, but also at the structural and functional level using neuroimaging techniques after our intervention.
- In addition to the aforementioned benefits, this therapeutic tool can improve some clinical-analytical markers used in the follow-up of cancer survivors, such as immunological markers like lymphocyte populations and inflammatory cytokines.
- The neurocognitive effects of this therapy are not only produced at the time of the intervention, but remain until months after the intervention.
- The positive impact of the treatment is not only observed in the patients, but also in the psychological and emotional state of the family members.
Read more
VARIABLES
- Clinically relevant improvement with moderate or large effect size in the following parameters as measured by neuropsychological tests.
- Statistically significant changes in neuroimaging tests.
- Statistically significant changes in immune and inflammatory biomarkers before and after treatment.
STUDY DESIGN In this clinical trial, randomized versus control group, unblinded, the aim is to demonstrate the neuropsychological, structural and functional benefit of an intervention using video games in child cancer survivors.
POPULATION OF THE STUDY The target population participating in the study will include patients of either sex aged 8-17 years who completed cancer treatment 1-5 years ago. They must have received treatment with neurotoxic potential: intrathecal/intraventricular chemotherapy, high-dose chemotherapy with crossing of the blood-brain barrier, CNS radiotherapy or hematopoietic stem cell transplantation (HSCT).
Read the detailed description
BACKGROUND AND RATIONALE Several authors have described specific cognitive damage following cancer treatments (often chemotherapy and radiotherapy), which has been termed "chemo-brain". This condition produces alterations in different neurocognitive fields such as memory, learning, concentration, reasoning, executive functions, attention and visuospatial skills.
In this research project the investigator team propose an intervention aimed at one of the most limiting adverse effects of cancer and its treatment such as neurocognitive deficits through technological game platforms and brain training used in a directed, controlled and supervised manner.
HYPOTHESIS
- Neurocognitive deficits in cancer survivors are underestimated. They represent a very limiting long-term side effect in this group of patients.
- An individualized, planned and limited intervention using technological gaming can improve neurocognitive function in these pediatric patients by taking advantage of the plasticity of the central nervous system (CNS) in the pediatric age.
- Changes can be demonstrated not only at the cognitive level, but also at the structural and functional level using neuroimaging techniques after our intervention.
- In addition to the aforementioned benefits, this therapeutic tool can improve some clinical-analytical markers used in the follow-up of cancer survivors, such as immunological markers like lymphocyte populations and inflammatory cytokines.
- The neurocognitive effects of this therapy are not only produced at the time of the intervention, but remain until months after the intervention.
- The positive impact of the treatment is not only observed in the patients, but also in the psychological and emotional state of the family members.
VARIABLES
- Clinically relevant improvement with moderate or large effect size in the following parameters as measured by neuropsychological tests: TAVECI/TAVEC, CATA, TONI-4 (form A), Digits, SDMT, ROCF, TFV, Stroop, Vocabulary
- Statistically significant changes in neuroimaging tests. The following variables will be measured:
- Structural imaging: volume measurement and Voxel Based Morphometry
- Diffusion Imaging: diffusion maps and structural connectivity
- Functional imaging: resting state and task based fMRI
- Statistically significant changes in immune and inflammatory biomarkers before and after treatment:
- Study of lymphocyte populations by parametric flow cytometry: T lymphocytes, B lymphocytes, natural killer (NK) lymphocytes, NK T lymphocytes
- Study of inflammatory cytokines by LUMINEX: IL-2, IL-4, IL-6, TNF alpha, IFN gamma, IL-10, IL-17TH, IL-1R antagonist
STUDY DESIGN
In this clinical trial, randomized versus control group, unblinded, the aim is to demonstrate the neuropsychological, structural and functional benefit of an intervention using video games in child cancer survivors, patients will follow the following phases:
- Informed consent
- Recruitment, inclusion and exclusion criteria.
- Initial T0 assessment
- Randomization
- Treatment phase for the intervention group. Waiting phase for control group
- Early post-treatment evaluation T+3
- Late post-treatment evaluation T+6
POPULATION OF THE STUDY The target population participating in the study will include patients of either sex aged 8-17 years who completed cancer treatment 1-5 years ago. They must have received treatment with neurotoxic potential: intrathecal/intraventricular chemotherapy, high-dose chemotherapy with crossing of the blood-brain barrier, CNS radiotherapy or hematopoietic stem cell transplantation (HSCT).
TREATMENT OF THE STUDY Type of intervention
Cognitive training through 3 types of video games:
- "Serious games" or "brain-training games".
- Exer-gaming
- Skill-training games Method of administration
The patient will receive the treatment for a period of 12 weeks, in which they will commit to use the video games of the intervention with the following pattern:
- "Brain-training game": sessions of 7-12 minutes with a frequency of 4 days a week.
- "Exer-gaming": sessions of 15-20 minutes 2 days a week.
- "Skill-training games": sessions of 15-20 minutes 2 days a week.
SAMPLE SIZE It is planned to recruit 56 patients (28 patients for each group, of which 14 will be from the 8-12 years age group and 14 will be from the 13-17 years age group). Recruitment will be for 12 months, with a follow-up period for each patient of 6 months.
- Conditions
- Survivors of Childhood Cancer
- Being tested
- Video game based training
- Keywords
- Cancer Survivors, Survivors of Childhood Cancer, Chemotherapy-related Cognitive Impairment, Functional Magnetic Resonance Imaging (fMRI), Video Games, Exergaming
- Medical subject headings
- Chemotherapy-Related Cognitive Impairment
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Video game based trainingBehavioural
Type of intervention: Cognitive training through 3 types of video games:
- "Serious games" or "brain-training games".
- Exer-gaming
- Skill-training games
Method of administration: The patient will receive the treatment for a period of 12 weeks, in which they will commit to use the video games of the intervention with the following pattern:
- "Brain-training game": sessions of 7-12 minutes with a frequency of 4 days a week.
- "Exer-gaming": sessions of 15-20 minutes 2 days a week.
- "Skill-training games": sessions of 15-20 minutes 2 days a week.
| Study group | Role | What they receive |
|---|---|---|
| Intervention group with video game-based training | Experimental | Cognitive training through 3 types of video games:
* "Serious games" or "brain-training games".
* Exer-gaming
* Skill-training games Method of administration
The patient will receive the treatment for a period of 12 weeks, in which they will commit to use the video games of the intervention with the following pattern:
* "Brain-training game": sessions of 7-12 minutes with a frequency of 4 days a week.
* "Exer-gaming": sessions of 15-20 minutes 2 days a week.
* "Skill-training games": sessions of 15-20 minutes 2 days a week. Receives: Behavioral: Video game based training |
| Waiting group (no training) | No intervention | Patients in waiting group will not receive treatment whilst the 3 month period. |
What is being measured
The primary outcome is the main question the study is designed to answer.
SDMT Test
To evaluate the benefits of treatment at the neurocognitive level by means of neuropsychological tests.
Measured: Baseline
Change in SDMT Test
To evaluate the benefits of treatment at the neurocognitive level by means of neuropsychological tests.
Measured: At 3 months after recruitment
Change in SDMT Test
To evaluate the benefits of treatment at the neurocognitive level by means of neuropsychological tests.
Measured: At 6 months after recruitment
"DIGITOS" Test
To evaluate the benefits of treatment at the neurocognitive level (processing speed)
Measured: Baseline
Change in "DIGITOS" Test
To evaluate the benefits of treatment at the neurocognitive level (processing speed)
Measured: At 3 months after recruitment
Change in "DIGITOS" Test
To evaluate the benefits of treatment at the neurocognitive level (processing speed)
Measured: At 6 months after recruitment
"TONI-4" test
To evaluate the benefits of treatment at the neurocognitive level (non-verbal intelligence)
Measured: Baseline
Change in "TONI-4" test
To evaluate the benefits of treatment at the neurocognitive level (non-verbal intelligence)
Measured: At 3 months after recruitment
Change in "TONI-4" test
To evaluate the benefits of treatment at the neurocognitive level (non-verbal intelligence)
Measured: At 6 months after recruitment
"ROCF" test
To evaluate the benefits of treatment at the neurocognitive level (visuo-constructional ability and non-verbal memory)
Measured: Baseline
Change in "ROCF" test
To evaluate the benefits of treatment at the neurocognitive level (visuo-constructional ability and non-verbal memory)
Measured: At 3 months after recruitment
Change in "ROCF" test
To evaluate the benefits of treatment at the neurocognitive level (visuo-constructional ability and non-verbal memory)
Measured: At 6 months after recruitment
"TFV" test
To evaluate the benefits of treatment at the neurocognitive level (verbal fluency)
Measured: Baseline
Change in "TFV" test
To evaluate the benefits of treatment at the neurocognitive level (verbal fluency)
Measured: At 3 months after recruitment
Change in "TFV" test
To evaluate the benefits of treatment at the neurocognitive level (verbal fluency)
Measured: At 6 months after recruitment
"STROOP" test
To evaluate the benefits of treatment at the neurocognitive level (selective attention and inhibitory control)
Measured: Baseline
Change in "STROOP" test
To evaluate the benefits of treatment at the neurocognitive level (selective attention and inhibitory control)
Measured: At 3 months after recruitment
Change in "STROOP" test
To evaluate the benefits of treatment at the neurocognitive level (selective attention and inhibitory control)
Measured: At 6 months after recruitment
"TAVECI" test
To evaluate the benefits of treatment at the neurocognitive level (verbal learning)
Measured: Baseline
Change in "TAVECI" test
To evaluate the benefits of treatment at the neurocognitive level (verbal learning)
Measured: At 3 months after recruitment
Change in "TAVECI" test
To evaluate the benefits of treatment at the neurocognitive level (verbal learning)
Measured: At 6 months after recruitment
"CPT3"
To evaluate the benefits of treatment at the neurocognitive level (performance in attention tasks)
Measured: Baseline
Change in "CPT3"
To evaluate the benefits of treatment at the neurocognitive level (performance in attention tasks)
Measured: At 3 months after recruitment
Change in "CPT3"
To evaluate the benefits of treatment at the neurocognitive level (performance in attention tasks)
Measured: At 6 months after recruitment
"BRIEF" survey
To evaluate the benefits of treatment at the neurocognitive level (assessment of executive functions by parents)
Measured: Baseline
Change in "BRIEF" survey
To evaluate the benefits of treatment at the neurocognitive level (assessment of executive functions by parents)
Measured: At 3 months after recruitment
Change in "BRIEF" survey
To evaluate the benefits of treatment at the neurocognitive level (assessment of executive functions by parents)
Measured: At 6 months after recruitment
"BASC" survey
To evaluate the benefits of treatment at the neurocognitive level (Behavior Assesment)
Measured: Baseline
Change in "BASC" survey
To evaluate the benefits of treatment at the neurocognitive level (Behavior Assesment)
Measured: At 3 months after recruitment
Change in "BASC" survey
To evaluate the benefits of treatment at the neurocognitive level (Behavior Assesment)
Measured: At 6 months after recruitment
Statistically significant changes in neuroimaging tests
Changes in structural imaging (white matter volume, gray matter volume and total intracranial volume, brain lobe volume and voxel-based morphometry), in diffusion (diffusion maps and structural connectivity) and in functional imaging (resting-state fMRI and task-based fMRI).
Measured: At 3 months after recruitment
Statistically significant changes in neuroimaging tests
Changes in structural imaging (white matter volume, gray matter volume and total intracranial volume, brain lobe volume and voxel-based morphometry), in diffusion (diffusion maps and structural connectivity) and in functional imaging (resting-state fMRI and task-based fMRI).
Measured: At 6 months after recruitment
Immune and inflammatory biomarkers
Study of lymphocyte populations by parametric flow cytometry (T lymphocytes, B lymphocytes, NK lymphocytes, NK T lymphocytes) and inflammatory cytokines by LUMINEX (IL-2, IL-4, IL-6, TNF alpha, IFN gamma, IL-10, IL-17a, IL-1R antagonist)
Measured: Baseline
Statistically significant changes in immune and inflammatory biomarkers
Study of lymphocyte populations by parametric flow cytometry (T lymphocytes, B lymphocytes, NK lymphocytes, NK T lymphocytes) and inflammatory cytokines by LUMINEX (IL-2, IL-4, IL-6, TNF alpha, IFN gamma, IL-10, IL-17a, IL-1R antagonist)
Measured: At 3 months after recruitment
Statistically significant changes in immune and inflammatory biomarkers
Study of lymphocyte populations by parametric flow cytometry (T lymphocytes, B lymphocytes, NK lymphocytes, NK T lymphocytes) and inflammatory cytokines by LUMINEX (IL-2, IL-4, IL-6, TNF alpha, IFN gamma, IL-10, IL-17a, IL-1R antagonist)
Measured: At 6 months after recruitment
Secondary outcomes (2)
Prevalence
To define the prevalence of neurocognitive deficit in cancer survivors in our population.
Measured: Baseline
Perception of the family measured by satisfaction survey
To analyze the psychological and emotional perception of family members after a controlled intervention using video games.
Measured: Through study completion, 6 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Mar 2024
- Study start23 Feb 2023
- Primary completionSep 2024 (estimated)
- Study completionFeb 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (13)Papers the sponsor has linked to this study.
- Other trials for Survivors of Childhood CancerStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Randomized versus control group clinical trial.
- Masking
- None (open label)
- Enrolment
- 56 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Antonio Pérez Martínez
- Sponsor type
- University, hospital or other
- Collaborators
- Hospital Ruber Internacional, Universidad Rey Juan Carlos
- Responsible party
- Sponsor-investigator, Antonio Pérez Martínez, Instituto de Investigación Hospital Universitario La Paz
- Investigators
- Antonio Pérez-Martínez, PhD, Principal investigator, Hospital la Paz
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06312969
- Sponsor's protocol ID
- 2022.301
- Acronym
- WINNERS
- Status last verified
- Mar 2024
- First submitted
- 9 Jun 2023
- Last updated
- 15 Mar 2024
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: all collected IPD
Publications
Alonso Puig M, Alonso-Prieto M, Miro J, Torres-Luna R, Plaza Lopez de Sabando D, Reinoso-Barbero F. The Association Between Pain Relief Using Video Games and an Increase in Vagal Tone in Children With Cancer: Analytic Observational Study With a Quasi-Experimental Pre/Posttest Methodology. J Med Internet Res. 2020 Mar 30;22(3):e16013. doi: 10.2196/16013.
PubMed 32224482Argyriou AA, Assimakopoulos K, Iconomou G, Giannakopoulou F, Kalofonos HP. Either called "chemobrain" or "chemofog," the long-term chemotherapy-induced cognitive decline in cancer survivors is real. J Pain Symptom Manage. 2011 Jan;41(1):126-39. doi: 10.1016/j.jpainsymman.2010.04.021. Epub 2010 Sep 15.
PubMed 20832978Semendric I, Pollock D, Haller OJ, George RP, Collins-Praino LE, Whittaker AL. Impact of "chemobrain" in childhood cancer survivors on social, academic, and daily living skills: a qualitative systematic review protocol. JBI Evid Synth. 2022 Jan 1;20(1):222-228. doi: 10.11124/JBIES-21-00115.
PubMed 34341312Dovis S, Van der Oord S, Wiers RW, Prins PJ. Improving executive functioning in children with ADHD: training multiple executive functions within the context of a computer game. a randomized double-blind placebo controlled trial. PLoS One. 2015 Apr 6;10(4):e0121651. doi: 10.1371/journal.pone.0121651. eCollection 2015.
PubMed 25844638Gerbie MV. Management of the adolescent girl exposed in utero to DES. Pediatr Ann. 1981 Dec;10(12):23-6.
PubMed 7335401Conklin HM, Ogg RJ, Ashford JM, Scoggins MA, Zou P, Clark KN, Martin-Elbahesh K, Hardy KK, Merchant TE, Jeha S, Huang L, Zhang H. Computerized Cognitive Training for Amelioration of Cognitive Late Effects Among Childhood Cancer Survivors: A Randomized Controlled Trial. J Clin Oncol. 2015 Nov 20;33(33):3894-902. doi: 10.1200/JCO.2015.61.6672. Epub 2015 Oct 12.
PubMed 26460306Conklin HM, Ashford JM, Clark KN, Martin-Elbahesh K, Hardy KK, Merchant TE, Ogg RJ, Jeha S, Huang L, Zhang H. Long-Term Efficacy of Computerized Cognitive Training Among Survivors of Childhood Cancer: A Single-Blind Randomized Controlled Trial. J Pediatr Psychol. 2017 Mar 1;42(2):220-231. doi: 10.1093/jpepsy/jsw057.
PubMed 27342301Benzing V, Eggenberger N, Spitzhuttl J, Siegwart V, Pastore-Wapp M, Kiefer C, Slavova N, Grotzer M, Heinks T, Schmidt M, Conzelmann A, Steinlin M, Everts R, Leibundgut K. The Brainfit study: efficacy of cognitive training and exergaming in pediatric cancer survivors - a randomized controlled trial. BMC Cancer. 2018 Jan 3;18(1):18. doi: 10.1186/s12885-017-3933-x.
PubMed 29298678da Silva Alves R, Abdalla DR, Iunes DH, Mariano KOP, Borges JBC, Murta EFC, Michelin MA, Carvalho LC. Influence of an Exergaming Training Program on Reducing the Expression of IL-10 and TGF-beta in Cancer Patients. Games Health J. 2020 Dec;9(6):446-452. doi: 10.1089/g4h.2020.0022. Epub 2020 Jun 4.
PubMed 32498637Spitzhuttl JS, Kronbichler M, Kronbichler L, Benzing V, Siegwart V, Pastore-Wapp M, Kiefer C, Slavova N, Grotzer M, Roebers CM, Steinlin M, Leibundgut K, Everts R. Impact of non-CNS childhood cancer on resting-state connectivity and its association with cognition. Brain Behav. 2021 Jan;11(1):e01931. doi: 10.1002/brb3.1931. Epub 2020 Nov 18.
PubMed 33205895Lee H, Voss MW, Prakash RS, Boot WR, Vo LT, Basak C, Vanpatter M, Gratton G, Fabiani M, Kramer AF. Videogame training strategy-induced change in brain function during a complex visuomotor task. Behav Brain Res. 2012 Jul 1;232(2):348-57. doi: 10.1016/j.bbr.2012.03.043. Epub 2012 Apr 6.
PubMed 22504276Richlan F, Schubert J, Mayer R, Hutzler F, Kronbichler M. Action video gaming and the brain: fMRI effects without behavioral effects in visual and verbal cognitive tasks. Brain Behav. 2017 Dec 16;8(1):e00877. doi: 10.1002/brb3.877. eCollection 2018 Jan.
PubMed 29568680Gonzalez-Perez C, Fernandez-Jimenez E, Moran E, Melero H, Malpica N, Alvarez-Linera J, Alonso Puig M, Plaza D, Perez-Martinez A. Study protocol for a randomized controlled clinical trial of a multifaceted cognitive training program using video games in childhood cancer survivors. PLoS One. 2025 Sep 2;20(9):e0314118. doi: 10.1371/journal.pone.0314118. eCollection 2025.
PubMed 40892751
Study at a glance
From the registry record, last updated by the sponsor on 15 Mar 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Cognitive Training Through Technological Gaming To Ameliorate Cognitive Effects Related To Childhood Cancer Treatment (WINNERS)
- ClinicalTrials.gov ID
- NCT06312969
- Acronym / sponsor ID
- WINNERS / 2022.301
- Conditions
- Survivors of Childhood Cancer
- Keywords
- Cancer Survivors, Survivors of Childhood Cancer, Chemotherapy-related Cognitive Impairment, Functional Magnetic Resonance Imaging (fMRI), Video Games, Exergaming
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 56 participants (estimated)
- Lead sponsor
- Antonio Pérez MartínezUniversity, hospital or other
- Collaborators
- Hospital Ruber Internacional, Universidad Rey Juan Carlos
- Study start
- 23 Feb 2023 (actual)
- Primary completion
- Sep 2024 (estimated)
- Study completion
- Feb 2025 (estimated)
- First posted
- 15 Mar 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
HYPOTHESIS
- Neurocognitive deficits in cancer survivors are underestimated. They represent a very limiting long-term side effect in this group of patients.
- An individualized, planned and limited intervention using technological gaming can improve neurocognitive function in these pediatric patients by taking advantage of the plasticity of the central nervous system (CNS) in the pediatric age.
- Changes can be demonstrated not only at the cognitive level, but also at the structural and functional level using neuroimaging techniques after our intervention.
- In addition to the aforementioned benefits, this therapeutic tool can improve some clinical-analytical markers used in the follow-up of cancer survivors, such as immunological markers like lymphocyte populations and inflammatory cytokines.
- The neurocognitive effects of this therapy are not only produced at the time of the intervention, but remain until months after the intervention.
- The positive impact of the treatment is not only observed in the patients, but also in the psychological and emotional state of the family members.
VARIABLES
- Clinically relevant improvement with moderate or large effect size in the following parameters as measured by neuropsychological tests.
- Statistically significant changes in neuroimaging tests.
- Statistically significant changes in immune and inflammatory biomarkers before and after treatment.
STUDY DESIGN In this clinical trial, randomized versus control group, unblinded, the aim is to demonstrate the neuropsychological, structural and functional benefit of an intervention using video games in child cancer survivors.
POPULATION OF THE STUDY The target population participating in the study will include patients of either sex aged 8-17 years who completed cancer treatment 1-5 years ago. They must have received treatment with neurotoxic potential: intrathecal/intraventricular chemotherapy, high-dose chemotherapy with crossing of the blood-brain barrier, CNS radiotherapy or hematopoietic stem cell transplantation (HSCT).
Detailed description
BACKGROUND AND RATIONALE Several authors have described specific cognitive damage following cancer treatments (often chemotherapy and radiotherapy), which has been termed "chemo-brain". This condition produces alterations in different neurocognitive fields such as memory, learning, concentration, reasoning, executive functions, attention and visuospatial skills.
In this research project the investigator team propose an intervention aimed at one of the most limiting adverse effects of cancer and its treatment such as neurocognitive deficits through technological game platforms and brain training used in a directed, controlled and supervised manner.
HYPOTHESIS
- Neurocognitive deficits in cancer survivors are underestimated. They represent a very limiting long-term side effect in this group of patients.
- An individualized, planned and limited intervention using technological gaming can improve neurocognitive function in these pediatric patients by taking advantage of the plasticity of the central nervous system (CNS) in the pediatric age.
- Changes can be demonstrated not only at the cognitive level, but also at the structural and functional level using neuroimaging techniques after our intervention.
- In addition to the aforementioned benefits, this therapeutic tool can improve some clinical-analytical markers used in the follow-up of cancer survivors, such as immunological markers like lymphocyte populations and inflammatory cytokines.
- The neurocognitive effects of this therapy are not only produced at the time of the intervention, but remain until months after the intervention.
- The positive impact of the treatment is not only observed in the patients, but also in the psychological and emotional state of the family members.
VARIABLES
- Clinically relevant improvement with moderate or large effect size in the following parameters as measured by neuropsychological tests: TAVECI/TAVEC, CATA, TONI-4 (form A), Digits, SDMT, ROCF, TFV, Stroop, Vocabulary
- Statistically significant changes in neuroimaging tests. The following variables will be measured:
- Structural imaging: volume measurement and Voxel Based Morphometry
- Diffusion Imaging: diffusion maps and structural connectivity
- Functional imaging: resting state and task based fMRI
- Statistically significant changes in immune and inflammatory biomarkers before and after treatment:
- Study of lymphocyte populations by parametric flow cytometry: T lymphocytes, B lymphocytes, natural killer (NK) lymphocytes, NK T lymphocytes
- Study of inflammatory cytokines by LUMINEX: IL-2, IL-4, IL-6, TNF alpha, IFN gamma, IL-10, IL-17TH, IL-1R antagonist
STUDY DESIGN
In this clinical trial, randomized versus control group, unblinded, the aim is to demonstrate the neuropsychological, structural and functional benefit of an intervention using video games in child cancer survivors, patients will follow the following phases:
- Informed consent
- Recruitment, inclusion and exclusion criteria.
- Initial T0 assessment
- Randomization
- Treatment phase for the intervention group. Waiting phase for control group
- Early post-treatment evaluation T+3
- Late post-treatment evaluation T+6
POPULATION OF THE STUDY The target population participating in the study will include patients of either sex aged 8-17 years who completed cancer treatment 1-5 years ago. They must have received treatment with neurotoxic potential: intrathecal/intraventricular chemotherapy, high-dose chemotherapy with crossing of the blood-brain barrier, CNS radiotherapy or hematopoietic stem cell transplantation (HSCT).
TREATMENT OF THE STUDY Type of intervention
Cognitive training through 3 types of video games:
- "Serious games" or "brain-training games".
- Exer-gaming
- Skill-training games Method of administration
The patient will receive the treatment for a period of 12 weeks, in which they will commit to use the video games of the intervention with the following pattern:
- "Brain-training game": sessions of 7-12 minutes with a frequency of 4 days a week.
- "Exer-gaming": sessions of 15-20 minutes 2 days a week.
- "Skill-training games": sessions of 15-20 minutes 2 days a week.
SAMPLE SIZE It is planned to recruit 56 patients (28 patients for each group, of which 14 will be from the 8-12 years age group and 14 will be from the 13-17 years age group). Recruitment will be for 12 months, with a follow-up period for each patient of 6 months.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Randomized versus control group clinical trial.
| Arm | Type | Receives |
|---|---|---|
| Intervention group with video game-based training | Experimental | Behavioral: Video game based trainingCognitive training through 3 types of video games: * "Serious games" or "brain-training games". * Exer-gaming * Skill-training games Method of administration The patient will receive the treatment for a period of 12 weeks, in which they will commit to use the video games of the intervention with the following pattern: * "Brain-training game": sessions of 7-12 minutes with a frequency of 4 days a week. * "Exer-gaming": sessions of 15-20 minutes 2 days a week. * "Skill-training games": sessions of 15-20 minutes 2 days a week. |
| Waiting group (no training) | No intervention | –Patients in waiting group will not receive treatment whilst the 3 month period. |
Who may qualify
- Ages
- 8 to 17 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child
Key inclusion criteria (14 listed)
- Patients between 8 and 17 years of age at the time of recruitment.
- Have completed treatment between 1 and 6 years prior to recruitment.
- Have had one of the following diagnoses:
- Having received at least one of the following treatments:
- Informed consent signed by parent/guardian.
Key exclusion criteria (8 listed)
- Active oncologic disease or relapse of active oncologic disease.
- Prior neurological or psychiatric pathology that may preclude trial or treatment evaluations:
- Current or recent (less than 1 year) use of other cognitive stimulation or brain training that may interfere with study results.
- Refusal to abstain from the use of the study treatment games in case of being assigned to group B (control group).
- Medical treatment that may significantly interfere with neuropsychological, imaging or biomarker assessments.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Video game based trainingType of intervention: Cognitive training through 3 types of video games: * "Serious games" or "brain-training games". * Exer-gaming * Skill-training games Method of administration: The patient will receive the treatment for a period of 12 weeks, in which they will commit to use the video games of the intervention with the following pattern: * "Brain-training game": sessions of 7-12 minutes with a frequency of 4 days a week. * "Exer-gaming": sessions of 15-20 minutes 2 days a week. * "Skill-training games": sessions of 15-20 minutes 2 days a week. | Behavioural | Intervention group with video game-based training |
Primary outcome
SDMT Test
Time frame: Baseline
To evaluate the benefits of treatment at the neurocognitive level by means of neuropsychological tests.
Change in SDMT Test
Time frame: At 3 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level by means of neuropsychological tests.
Change in SDMT Test
Time frame: At 6 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level by means of neuropsychological tests.
"DIGITOS" Test
Time frame: Baseline
To evaluate the benefits of treatment at the neurocognitive level (processing speed)
Change in "DIGITOS" Test
Time frame: At 3 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (processing speed)
Change in "DIGITOS" Test
Time frame: At 6 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (processing speed)
"TONI-4" test
Time frame: Baseline
To evaluate the benefits of treatment at the neurocognitive level (non-verbal intelligence)
Change in "TONI-4" test
Time frame: At 3 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (non-verbal intelligence)
Change in "TONI-4" test
Time frame: At 6 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (non-verbal intelligence)
"ROCF" test
Time frame: Baseline
To evaluate the benefits of treatment at the neurocognitive level (visuo-constructional ability and non-verbal memory)
Change in "ROCF" test
Time frame: At 3 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (visuo-constructional ability and non-verbal memory)
Change in "ROCF" test
Time frame: At 6 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (visuo-constructional ability and non-verbal memory)
"TFV" test
Time frame: Baseline
To evaluate the benefits of treatment at the neurocognitive level (verbal fluency)
Change in "TFV" test
Time frame: At 3 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (verbal fluency)
Change in "TFV" test
Time frame: At 6 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (verbal fluency)
"STROOP" test
Time frame: Baseline
To evaluate the benefits of treatment at the neurocognitive level (selective attention and inhibitory control)
Change in "STROOP" test
Time frame: At 3 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (selective attention and inhibitory control)
Change in "STROOP" test
Time frame: At 6 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (selective attention and inhibitory control)
"TAVECI" test
Time frame: Baseline
To evaluate the benefits of treatment at the neurocognitive level (verbal learning)
Change in "TAVECI" test
Time frame: At 3 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (verbal learning)
Change in "TAVECI" test
Time frame: At 6 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (verbal learning)
"CPT3"
Time frame: Baseline
To evaluate the benefits of treatment at the neurocognitive level (performance in attention tasks)
Change in "CPT3"
Time frame: At 3 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (performance in attention tasks)
Change in "CPT3"
Time frame: At 6 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (performance in attention tasks)
"BRIEF" survey
Time frame: Baseline
To evaluate the benefits of treatment at the neurocognitive level (assessment of executive functions by parents)
Change in "BRIEF" survey
Time frame: At 3 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (assessment of executive functions by parents)
Change in "BRIEF" survey
Time frame: At 6 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (assessment of executive functions by parents)
"BASC" survey
Time frame: Baseline
To evaluate the benefits of treatment at the neurocognitive level (Behavior Assesment)
Change in "BASC" survey
Time frame: At 3 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (Behavior Assesment)
Change in "BASC" survey
Time frame: At 6 months after recruitment
To evaluate the benefits of treatment at the neurocognitive level (Behavior Assesment)
Statistically significant changes in neuroimaging tests
Time frame: At 3 months after recruitment
Changes in structural imaging (white matter volume, gray matter volume and total intracranial volume, brain lobe volume and voxel-based morphometry), in diffusion (diffusion maps and structural connectivity) and in functional imaging (resting-state fMRI and task-based fMRI).
Statistically significant changes in neuroimaging tests
Time frame: At 6 months after recruitment
Changes in structural imaging (white matter volume, gray matter volume and total intracranial volume, brain lobe volume and voxel-based morphometry), in diffusion (diffusion maps and structural connectivity) and in functional imaging (resting-state fMRI and task-based fMRI).
Immune and inflammatory biomarkers
Time frame: Baseline
Study of lymphocyte populations by parametric flow cytometry (T lymphocytes, B lymphocytes, NK lymphocytes, NK T lymphocytes) and inflammatory cytokines by LUMINEX (IL-2, IL-4, IL-6, TNF alpha, IFN gamma, IL-10, IL-17a, IL-1R antagonist)
Statistically significant changes in immune and inflammatory biomarkers
Time frame: At 3 months after recruitment
Study of lymphocyte populations by parametric flow cytometry (T lymphocytes, B lymphocytes, NK lymphocytes, NK T lymphocytes) and inflammatory cytokines by LUMINEX (IL-2, IL-4, IL-6, TNF alpha, IFN gamma, IL-10, IL-17a, IL-1R antagonist)
Statistically significant changes in immune and inflammatory biomarkers
Time frame: At 6 months after recruitment
Study of lymphocyte populations by parametric flow cytometry (T lymphocytes, B lymphocytes, NK lymphocytes, NK T lymphocytes) and inflammatory cytokines by LUMINEX (IL-2, IL-4, IL-6, TNF alpha, IFN gamma, IL-10, IL-17a, IL-1R antagonist)
2 secondary outcomes
Prevalence
Time frame: Baseline
Perception of the family measured by satisfaction survey
Time frame: Through study completion, 6 months
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Mar 2024.
- Background: PubMed 32224482Alonso Puig M, Alonso-Prieto M, Miro J, Torres-Luna R, Plaza Lopez de Sabando D, Reinoso-Barbero F. The Association Between Pain Relief Using Video Games and an Increase in Vagal Tone in Children With Cancer: Analytic Observational Study With a Quasi-Experimental Pre/Posttest Methodology. J Med Internet Res. 2020 Mar 30;22(3):e16013. doi: 10.2196/16013.
- Background: PubMed 20832978Argyriou AA, Assimakopoulos K, Iconomou G, Giannakopoulou F, Kalofonos HP. Either called "chemobrain" or "chemofog," the long-term chemotherapy-induced cognitive decline in cancer survivors is real. J Pain Symptom Manage. 2011 Jan;41(1):126-39. doi: 10.1016/j.jpainsymman.2010.04.021. Epub 2010 Sep 15.
- Background: PubMed 34341312Semendric I, Pollock D, Haller OJ, George RP, Collins-Praino LE, Whittaker AL. Impact of "chemobrain" in childhood cancer survivors on social, academic, and daily living skills: a qualitative systematic review protocol. JBI Evid Synth. 2022 Jan 1;20(1):222-228. doi: 10.11124/JBIES-21-00115.
- Background: PubMed 25844638Dovis S, Van der Oord S, Wiers RW, Prins PJ. Improving executive functioning in children with ADHD: training multiple executive functions within the context of a computer game. a randomized double-blind placebo controlled trial. PLoS One. 2015 Apr 6;10(4):e0121651. doi: 10.1371/journal.pone.0121651. eCollection 2015.
- Background: PubMed 7335401Gerbie MV. Management of the adolescent girl exposed in utero to DES. Pediatr Ann. 1981 Dec;10(12):23-6.
- Background: PubMed 26460306Conklin HM, Ogg RJ, Ashford JM, Scoggins MA, Zou P, Clark KN, Martin-Elbahesh K, Hardy KK, Merchant TE, Jeha S, Huang L, Zhang H. Computerized Cognitive Training for Amelioration of Cognitive Late Effects Among Childhood Cancer Survivors: A Randomized Controlled Trial. J Clin Oncol. 2015 Nov 20;33(33):3894-902. doi: 10.1200/JCO.2015.61.6672. Epub 2015 Oct 12.
- Background: PubMed 27342301Conklin HM, Ashford JM, Clark KN, Martin-Elbahesh K, Hardy KK, Merchant TE, Ogg RJ, Jeha S, Huang L, Zhang H. Long-Term Efficacy of Computerized Cognitive Training Among Survivors of Childhood Cancer: A Single-Blind Randomized Controlled Trial. J Pediatr Psychol. 2017 Mar 1;42(2):220-231. doi: 10.1093/jpepsy/jsw057.
- Background: PubMed 29298678Benzing V, Eggenberger N, Spitzhuttl J, Siegwart V, Pastore-Wapp M, Kiefer C, Slavova N, Grotzer M, Heinks T, Schmidt M, Conzelmann A, Steinlin M, Everts R, Leibundgut K. The Brainfit study: efficacy of cognitive training and exergaming in pediatric cancer survivors - a randomized controlled trial. BMC Cancer. 2018 Jan 3;18(1):18. doi: 10.1186/s12885-017-3933-x.
- Background: PubMed 32498637da Silva Alves R, Abdalla DR, Iunes DH, Mariano KOP, Borges JBC, Murta EFC, Michelin MA, Carvalho LC. Influence of an Exergaming Training Program on Reducing the Expression of IL-10 and TGF-beta in Cancer Patients. Games Health J. 2020 Dec;9(6):446-452. doi: 10.1089/g4h.2020.0022. Epub 2020 Jun 4.
- Background: PubMed 33205895Spitzhuttl JS, Kronbichler M, Kronbichler L, Benzing V, Siegwart V, Pastore-Wapp M, Kiefer C, Slavova N, Grotzer M, Roebers CM, Steinlin M, Leibundgut K, Everts R. Impact of non-CNS childhood cancer on resting-state connectivity and its association with cognition. Brain Behav. 2021 Jan;11(1):e01931. doi: 10.1002/brb3.1931. Epub 2020 Nov 18.
- Background: PubMed 22504276Lee H, Voss MW, Prakash RS, Boot WR, Vo LT, Basak C, Vanpatter M, Gratton G, Fabiani M, Kramer AF. Videogame training strategy-induced change in brain function during a complex visuomotor task. Behav Brain Res. 2012 Jul 1;232(2):348-57. doi: 10.1016/j.bbr.2012.03.043. Epub 2012 Apr 6.
- Background: PubMed 29568680Richlan F, Schubert J, Mayer R, Hutzler F, Kronbichler M. Action video gaming and the brain: fMRI effects without behavioral effects in visual and verbal cognitive tasks. Brain Behav. 2017 Dec 16;8(1):e00877. doi: 10.1002/brb3.877. eCollection 2018 Jan.
- Individual participant dataSharing planned: Yes. all collected IPD
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Antonio Pérez-Martínez, PhD principal investigator
Hospital la Paz
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Video game based training in people with Survivors of Childhood Cancer, run by Antonio Pérez Martínez at 1 site in Spain.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 14 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 15 Mar 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Carlos Gonzalez-Perez, MD (0034917277223, carlos.gonzalez2@salud.madrid.org), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
SDMT Test (time frame: Baseline). The study lists 35 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06312969, which also lists 13 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Mar 2024.