Truman (2015) and Advanced Lung Cancer

Julián is an Argentine actor living in Madrid. He has been treated for cancer for about a year. His oldest friend Tomás flies in from Canada for four days without warning, and Julián immediately guesses why.

Rather than argue, Julián tells him plainly that he is stopping treatment. More chemotherapy would only postpone the inevitable. He would rather spend what is left putting things in order.

Those things are mostly small, and mostly about his ageing boxer dog, Truman. Who will take him? Will the dog grieve? Is the new owner good enough? He also settles his funeral arrangements and stops working.

His cousin Paula has carried much of the load. She is furious that he has given up and cannot bring herself to say so. He and Tomás fly to Amsterdam to see his son Nico, and Julián does not tell him he is dying. Back in Madrid, Tomás takes Truman home to Canada. The film ends on the goodbye. Julián's death is offscreen and certain.

The film's best decision is to treat stopping treatment as a considered choice rather than despair.

Oncologists do sometimes say honestly that more chemotherapy would buy weeks rather than years, at a cost in side effects. Deciding that the trade is not worth it is a legitimate answer, and Julián is allowed to give it without being argued out of it.

Paula's anger is realistic too. Families often experience that decision as abandonment. The film does not resolve the conflict, and it is honest that the choice is Julián's however much it costs the people around him.

Virginia Ruiz, a Spanish radiation oncologist who writes about oncology in film, reviewed Truman and named the central implausibility. In her words, Julián shows no outward sign of being ill: he does not tire, he does not cough, he has no pain, he eats well and he even looks well, none of which is usual in the advanced phase of the disease.

That is the whole problem in one sentence. He travels to Amsterdam, drinks, argues, walks Madrid, and looks like a man on holiday.

At the point where treatment is being stopped, lung cancer has normally made itself obvious.

NCI lists the signs and symptoms: chest discomfort or pain, a cough that does not go away or gets worse, trouble breathing, wheezing, blood in sputum, hoarseness, loss of appetite, weight loss for no known reason, fatigue, trouble swallowing, and swelling in the face or the veins of the neck.

Someone deciding to stop treatment is usually carrying several of those, not none.

There is no medication in Truman. No painkillers, no anti-sickness drugs, no oxygen, no district nurse, no palliative care team.

Stopping cancer treatment does not mean stopping treatment. It normally means swapping drugs aimed at the tumour for drugs aimed at breathlessness, pain, cough and sickness, plus a team on the end of a phone.

The film's neat four-day window lets Julián complete every arrangement on his own. Real illness rarely grants that, which is exactly why the practical conversations are worth having earlier than feels necessary.

Julián says that if his health collapses he intends to end his life on his own terms, and the film treats that as an available option.

It was not one. Spain legalised euthanasia through the Organic Law for the Regulation of Euthanasia, approved on 18 March 2021 and in force from 25 June 2021. The film was made and released years before that.

This matters because the same scene, watched today, reads as a description of a legal route. In 2015 it described something else entirely.

Lung cancer often causes nothing early. NCI notes it is sometimes found on a chest X-ray done for another reason.

Screening exists, but only for people at high risk from smoking. In March 2021 the US Preventive Services Task Force recommended annual low-dose CT scanning for adults aged 50 to 80 with a 20 pack-year smoking history who currently smoke or quit within the past 15 years. It is a grade B recommendation, and it widened the previous rule, which started at 55 and required 30 pack-years.

Everyone outside that group, including people who never smoked, has no recommended screening test. A meaningful share of lung cancers occur in people who never smoked, and those are found only once symptoms appear.

So the practical rule is about persistence. A cough lasting more than about three weeks should be assessed rather than waited out, and coughing up any blood at all should be assessed straight away.

The film is unusually good on the social awkwardness of terminal illness. People cross the street to avoid Julián. Acquaintances cannot find a sentence. He ends up reassuring everyone else.

It is also right about what the last weeks are actually made of. Paperwork. Funeral arrangements. Deciding who gets what. And, disproportionately, the future of a dog.

That is not a quirk of the script. When medical decisions run out, what remains is a list of small handovers, and people put enormous weight on the one that stands in for all of them.

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Truman is honest about how people behave around a dying friend and dishonest about what dying of lung cancer looks like. Julián is too well, for too long, with nothing to control.

If you are near this in real life, the useful question is the one the film never asks: who manages the symptoms after treatment stops? Ask for that team by name, early.

And if you have a cough that has lasted weeks, or you have coughed up blood, do not wait for a story to give you permission. Truman cannot tell you what to watch for, but screening and possible warning signs can.

• NCI — Non-Small Cell Lung Cancer Treatment (PDQ®), Patient Version
• US Preventive Services Task Force — Lung Cancer: Screening (2021)
• Virginia Ruiz — Cineterapia Oncológica: Truman (2015)

This page discusses Truman 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.