The Terry Fox Story (1983)

Terry Fox was 18 and an athlete when a pain in his right knee turned out to be osteosarcoma, a cancer that starts in bone. The Canadian Encyclopedia dates his diagnosis to 4 March 1977 and the amputation of his right leg above the knee to 9 March. A 16-month course of chemotherapy followed.

The film puts the weight where Fox put it. What changed him was not losing a leg. It was the cancer ward, and the other patients in it, many of them children.

He began training in mid-February 1979, when he could manage half a mile. By the time he set off he had logged more than 5,000 km in training runs. On 12 April 1980 he dipped his artificial leg in the Atlantic at St John's, Newfoundland, and started the Marathon of Hope. He averaged about 42 km a day, roughly a marathon, across the Atlantic provinces, Quebec and Ontario.

On 1 September 1980, after 143 days and 5,373 km, he was forced to stop outside Thunder Bay, Ontario. The cancer had reached his lungs. He never restarted. He died on 28 June 1981, aged 22.

Robert Duvall plays the publicist managing the press around him. The film ends where the run ended.

It does not tidy up the treatment. The amputation and the chemotherapy ward are grim rather than ennobling.

It is honest about what running on a late-1970s artificial leg cost him. The equipment was not built for a marathon a day, and the film keeps showing the price.

It also declines to make him saintly. He is impatient. He argues with organisers. He rejects being turned into an inspiration. Seriously ill people are routinely flattened into symbols, and the film pushes back on that even while making one.

Most importantly, it is clear that stopping was not a failure of will. Lung metastases ended the run. Nothing else could have.

It was made fast, within two years of his death, and it shows. The stretch from first symptom to amputation moves quicker on screen than it did in life. So does the training, which in reality took more than a year and thousands of kilometres before the run began.

The film also stops at Thunder Bay. His last nine months are barely there. That leaves out the part where metastatic osteosarcoma is at its hardest, and where the treatment of 1980 had least to offer.

One more caution. Fox was treated in 1977. Nothing in this story should be read as a description of current care.

NCI describes osteosarcoma as a rare bone cancer that starts in osteoblasts, the cells that build new bone. It is most common in adolescents and young adults. About 440 cases a year are diagnosed in the United States in people aged 19 and under.

It usually forms in the long bones of the arms and legs. More than half of people with osteosarcoma have it in the long bones near the knee, which is exactly where Fox's tumour was.

That single fact carries most of the practical message on this page. A bone cancer that concentrates in one joint, in one age group, is a pattern worth knowing.

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

• swelling over a bone or a bony part of the body
• pain in a bone or joint
• pain in the arm when lifting
• stiffness in a joint
• a limp or difficulty walking
• a bone that breaks for no known reason

Every one of those also describes a sports injury. Teenagers collect sprains, knocks and growing pains, and families have good reason to wait a week and see.

The problem is that osteosarcoma often surfaces after a minor injury, which then takes the blame. Fox's own tumour came to notice after a car accident.

The practical rule is about time, not severity. Bone pain that has not settled after a few weeks deserves an X-ray rather than more rest. So does swelling over a bone, and so does pain that keeps waking someone at night.

There is no screening test for osteosarcoma, and none is recommended for anyone at average risk.

That is not an oversight. Screening only makes sense when a disease is common enough that a test finds far more real cases than false alarms. At roughly 440 cases a year in a country of tens of millions of young people, any test would generate a flood of frightening false positives for every cancer caught.

So the route to earlier diagnosis is not a test you can ask for. It is acting on a symptom that has lasted.

If bone cancer is suspected, imaging comes first, usually X-ray, then MRI or CT. A biopsy confirms it.

Treatment is chemotherapy before surgery, then surgery, then more chemotherapy. Surgery is limb-sparing where possible: the tumour and a margin of healthy tissue come out, and the limb is rebuilt with a graft or an implant. NCI notes that limb-sparing surgery may still be possible even if the bone has fractured. Amputation is used when the whole tumour cannot be removed safely any other way.

That sequence is why an amputation today is a decision made with a surgeon about margins, not the automatic first step it can look like in a film set in 1977.

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The Marathon of Hope is a story about what one person did with the time he had. It is not a guide to bone cancer, and it was never trying to be.

The usable part is smaller and duller. A teenager with bone pain that will not settle, or swelling over a bone, should have an X-ray. Most of those X-rays will show nothing serious.

For more, see screening and possible warning signs.

• NCI — Osteosarcoma and UPS of Bone Treatment (PDQ®), Patient Version
• The Canadian Encyclopedia — Terry Fox
• The Terry Fox Foundation — Terry's Story

This page discusses The Terry Fox Story 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.