Once upon a tumour in Hollywood

In Tinseltown, cancer means curtains.

---

The way cancer is shown in the movies could affect how real-life patients understand their diagnosis, their thoughts on prognosis and treatment, and the way they engage with their doctor. 

That’s according to insights published this month in JCO Oncology Practice by a group of oncologists who reviewed 104 English-language films gleaned from the IMDB database, released between 2010 and 2020, with cancer as a keyword.  

They included:  

• 50/50 (2011) 
• The Fault in Our Stars (2014) 
• The Judge (2014) 
• Creed (2015) 
• Deadpool (2016) 
• Film Stars Don’t Live in Liverpool (2017) 
• Zoe and the Astronaut (2018) 
• London Mitchell’s Christmas (2019) 
• Hooking Up (2020) 
• All My Life (2020) 

It’s not that people are deliberately seeking out cancer information by watching Deadpool. (“A wisecracking mercenary gets experimented on and becomes immortal yet hideously scarred, and sets out to track down the man who ruined his looks,” the blurb reads).  

Rather, when people get a cancer diagnosis, they have “significant information needs”, the authors say, and look to a “plethora of sources, including family or friends, social media, or may reflect on previous exposure to cancer through films.” 

They found “startling differences” between depictions of cancer in the movies and real life in terms of distinguishing the type of cancer, available treatments, curability, palliative care and cost of treatment. 

“Oncologists should be aware of how cancer is depicted in movies to anticipate and address potential discrepancies between patients’ potential views and the reality of cancer care,” they write. 

If you’re really not up for the movie binge, here’s the cheat sheet on preconceived notions your patients may be carrying into a consultation: 

• Cancer is cancer is cancer. Only a third of storylines specified the type of cancer a character had. “As cancer treatment is most frequently determined by the tumour site and may vary further depending on subclassification, this is a significant deficiency,” the authors said. Unlike in the real world, in movie land, brain cancer is the most common kind, followed by breast, lung, leukemia, sarcoma, testicular, lymphoma, and gastric cancer. A crash course on cancer biology might be in order. 

• There’s no chance of survival. “Most film characters were depicted with incurable cancer, while the curability of cancer was unknown and unaddressed in other movies,” the authors write. This doesn’t reflect the many good options and outcomes that exist for patients. It could affect the way patients and caregivers think about available treatments, and it really doesn’t help promote the benefits of screening and early detection, they point out. 

• Your treatment options are chemo. That’s it. Immunotherapy hasn’t made it to Hollywood, let alone targeted therapies and personalised medicine. Even surgery and radiation rarely get a look-in. Multidisciplinary care – what’s that? A number of characters opted out of the extremely limited treatment on offer altogether. “Oncologists and treating physicians must be cognizant of the potential lack of awareness of these treatment modalities when offering and discussing one of these cancer-directed treatments,” the authors write. 

• Palliative care is not a thing. Only one in 10 cancer patients in the movies are offered it. This is a missed opportunity: “It is imperative that Hollywood gains greater insight into this valuable holistic care as many patients currently decline palliative care because of poor perceptions and lack of awareness.”  

• Ninety-nine problems, but money isn’t one of them. In fact, financial toxicity only rears its ugly head in four out of the 104 films viewed. “The lack of cinematic depiction of costs associated with cancer care mirrors real-world patient experiences with financial toxicity as many individuals are unaware of these costs… [Clinicians must] provide appropriate resources to help educate and mitigate the encompassing consequences related to the costs of cancer treatment,” the authors write. This is probably more of an issue in the US, but it is one here too. 

If Hollywood could do better, movies could do for oncology literacy what To Kill A Mockingbird did for race discrimination awareness and Philadelphia for LGBTQIA+ issues, according to the paper. 

But the authors do concede that “movies serve to predominantly provide entertainment, deliver revenue for production companies, and not to educate the public about the true nature of oncology”. 

No one’s going to fork out for a pair of movie tickets, popcorn and a choc top or even stay in for a budget-friendly night of two-minute-noodles and cancer education on Netflix, no matter how high the production values.  

Episodic viewing offers some hope. The multi-award-winning series Breaking Bad is built on the premise that a high school chemistry teacher turns to meth production and dealing to cover the cost of his cancer treatment. There probably isn’t a consumer of English-language screen culture over the age of 13 who isn’t now well aware that the financial cost of having cancer can blow up your life (and a few other things along the way). It really drives the point home. Maybe a little too well. 

Send medically accurate movie recs to penny@medicalrepublic.com.au.