The Sisterhood of the Traveling Pants (2005)

Four friends from Maryland spend their first summer apart. They mail one pair of jeans between them. Lena goes to Greece. Carmen visits her father and finds herself an outsider in his new household. Bridget chases a soccer coach in Baja. Tibby stays home, works a dull shop job, and films a sour documentary about the people around her.

A twelve-year-old named Bailey Graffman attaches herself to Tibby. She appoints herself assistant and will not be shaken off. Tibby learns that Bailey has leukaemia, a cancer of the blood and the bone marrow.

Bailey gets sicker as the summer goes on. Tibby is frightened and stops visiting the hospital. Then she goes back, and takes the jeans with her. Bailey dies. Tibby finishes the film she began as a joke and turns it into something for Bailey.

This page gives away the ending. There is no way to discuss the illness without doing that.

Most cancer films follow the patient. This one follows the person standing next to her, which is the harder trick.

Tibby cannot make herself walk into the hospital. Then she feels monstrous about it. That reaction is common and almost never dramatised. People stay away from a sick friend because they do not know what to say. The longer the silence runs, the harder it is to break.

If you recognise yourself in that, the fix is small and dull. Send a short message with no question in it. Turn up with a task rather than a speech. Bailey does not want a visitor who has prepared something.

Bailey herself is written as a person, not a lesson. She is bossy, funny and blunt, and more interested in Tibby than in her own prognosis.

Bailey is diagnosed, declines and dies inside a single summer. That is the film's largest liberty.

NCI's guidance for doctors says that treatment for childhood acute lymphoblastic leukaemia usually means chemotherapy given for two to three years. It is not one intense stretch. It runs in phases, and the last phase is the longest.

None of that is on screen. There are no chemotherapy cycles, no talk of remission or transplant, and no clinical trial. No oncology team appears at all. Bailey stays articulate and mostly comfortable until close to the end.

The effect is to make leukaemia look like a quiet fading. The real thing is long, crowded and exhausting, and most children come through it.

At Bailey's age, leukaemia usually means acute lymphoblastic leukaemia, or ALL. It starts in the blood-forming cells inside the bone marrow.

NCI reports that ALL is the most common cancer diagnosed in children. It accounts for about a quarter of cancer diagnoses in children under 15. Around 3,100 people under 20 are diagnosed with it each year in the United States.

The outlook has shifted hugely. Between 1975 and 2020 the five-year survival rate for children under 15 rose from 60% to about 90%. For teenagers aged 15 to 19 it rose from 28% to more than 75%.

The marrow is where blood is made, so the early signs are mostly signs of blood going wrong. Too few red cells brings tiredness and pallor. Too few platelets brings bruising and bleeding. Too few working white cells brings infections.

NCI tells parents to check with a doctor if a child has:

• fever
• easy bruising or bleeding
• flat, pinpoint, dark-red spots under the skin, called petechiae
• weakness, fatigue, or pale skin
• bone or joint pain
• shortness of breath or trouble breathing
• painless swollen lymph nodes in the neck, underarm, stomach or groin
• pain or a feeling of fullness below the ribs
• loss of appetite, weight loss or abdominal pain
• frequent infections, or infections that do not go away

Any one of these alone is usually something ordinary. What counts is a cluster of them, or symptoms that keep going instead of settling.

There is no screening test for childhood leukaemia, and no blood test is advised for healthy children. The disease is found because somebody acted on symptoms. That makes the list above matter more than it would for a cancer with a screening programme.

If a doctor suspects leukaemia, the first test is a full blood count. Confirming it takes a bone marrow aspiration and biopsy, genetic testing of the marrow cells, and a lumbar puncture to sample the fluid around the spinal cord.

The film catches something adults find hard to admit. Bailey spends much of her remaining time managing Tibby's feelings.

Seriously ill children often do this. They work out who can cope and who cannot. They edit what they say. They protect the grown-ups, and then have nowhere to put their own fear.

If you are the adult, one thing helps. Say the hard thing first, in plain words, so the child does not have to guard you.

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Bailey's summer is a story about grief, and it is good at that. It is not a picture of childhood leukaemia.

If you are here because a child in your life is tired, bruising and picking up infections, the film is not your evidence. A full blood count is. Ask for one.

Most of the time the answer will be something ordinary. Finding that out is the whole point. For more, see screening and possible warning signs.

• NCI — Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®), Patient Version
• NCI — Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®), Health Professional Version

This page discusses The Sisterhood of the Traveling Pants for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.