A Lion in the House (2006)

PBS premiered this documentary on Independent Lens on 21 June 2006. Its description is plain: five children fighting cancer over a span of six years, with their families, nurses and doctors.

PBS describes the five as Alex, a seven-year-old with dark eyes and curls; Tim, a quick-witted sixteen-year-old; Justin, nineteen and already ten years into fighting cancer; Jen, a quiet six-year-old; and Al, a wry eleven-year-old. Their family names appear in the credits: Alex Lougheed, Tim Woods, Justin Ashcraft, Jen Moone and Al Fields. Tim had Hodgkin lymphoma, Al non-Hodgkin lymphoma, and the others leukemia.

Three of the five die. Spoilers throughout — discussing the cancer story means discussing how it ends.

Six years is the whole argument of this film. Nothing is reconstructed, so it holds the parts that a two-hour drama has to cut.

The boredom. The repetition. A relapse that erases a year. The sibling who becomes depressed. The mother who leaves her job and does not go back. It is unusually honest about money, following a single parent with no car and a nursing aide who cannot afford both her medication and unpaid leave. Clinicians disagree with each other on camera, and with parents. The children are allowed to be funny, rude and frightened rather than saintly.

Its compression is where the license lies. Six years cut to a few hours makes flat stretches vanish, so outcomes look faster and more fated than they were.

This is the number to hold onto. NCI reports that 5-year survival for childhood acute lymphoblastic leukemia rose from 57 percent for children diagnosed in 1975 to 92.3 percent for those diagnosed in 2014 to 2020. For childhood non-Hodgkin lymphoma it rose from 43 percent to 91.4 percent over the same span.

Childhood cancer death rates fell by more than half between 1975 and 2022, from 5.1 to 2.2 per 100,000 children and adolescents. NCI's health-professional summary puts it more precisely for leukemia: about 98 percent of children reach remission, roughly 85 percent become long-term event-free survivors, and more than 90 percent are alive at 5 years.

Survival is not uniform. NCI's own figures show 5-year survival for lymphoid leukemias of 96 percent for children aged 1 to 4, but 61 percent for babies under one and 78 percent for adolescents. Age at diagnosis moves the number a lot.

The treatment filmed here dates from the late 1990s and early 2000s. Reading the specific drugs, doses and transplant decisions as current practice would be a mistake.

Two changes are worth naming. NCI's health-professional summary states that most newly diagnosed children with ALL are now treated without cranial radiation, which was once routine and drove some of the thinking problems survivors carried. And risk groups are now set partly by minimal residual disease: a very sensitive test for leukemia cells left in the marrow at the end of the first month of treatment. Neither tool was shaping care in the way it does now when this film was shot.

One structural fact has held. NCI reports that more than 90 percent of children and adolescents diagnosed with cancer in the United States are cared for at a center affiliated with the Children's Oncology Group, and that about 4,000 enroll in one of its trials each year. That is why treatment for childhood leukemia changes as fast as it does.

NCI's summary on childhood acute lymphoblastic leukemia gives thirteen things worth checking with a doctor:

• Fever.
• Easy bruising or bleeding.
• Petechiae: flat, pinpoint, dark-red spots under the skin.
• Weakness or fatigue.
• Pale skin.
• Bone or joint pain.
• Shortness of breath.
• 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.
• Abdominal pain.
• Frequent infections, or infections that do not clear.

Lymphoma more often starts as painless swollen nodes. When nodes in the chest press on an airway, a cough and breathlessness follow. That is the pattern behind the coughs and swollen necks the film shows being brushed off at first.

NCI lists four screening tests as effective: mammography, HPV and Pap testing, colorectal screening, and low-dose CT for heavy smokers. Every one of them is for adults.

There is no equivalent for childhood cancer. Nothing at a routine well-child visit is designed to find it, and these cancers are picked up because a symptom persisted and somebody investigated. So duration is the thing to act on, not severity. NCI does report that about 8 to 10 percent of childhood cancers are caused by an inherited change in a cancer predisposition gene, and its summary points families toward genetic counseling where the history suggests one. For how screening works where it does exist, see cancer screening.

Jen Moone's storyline is the one people forget. She finished treatment, stayed well, and lost ground at school.

NCI names the groups at highest risk of serious late effects: children treated for bone cancer, brain tumors or Hodgkin lymphoma, and any child who had radiation to the chest, abdomen or pelvis. The problems it lists include second cancers, joint replacement, hearing loss and congestive heart failure. Survivorship care is not an afterthought to this film. It is one of its five stories.

• https://www.pbs.org/independentlens/documentaries/lioninthehouse/
• https://cm-pressroom.pbs.org/-/media/pressroom/public-assets/programs/a/a-lion-in-the-house/lion-in-the-house-rls.doc
• https://www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet
• https://www.cancer.gov/types/leukemia/hp/child-all-treatment-pdq
• https://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq
• https://www.cancer.gov/about-cancer/screening/screening-tests

This page discusses A Lion in the House for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].