Funny People (2009): Leukemia, Remission and Regret

George Simmons is a rich stand-up who became the star of increasingly worthless studio comedies. He lives alone in a mansion. Then a doctor tells him he has a rare leukemia that conventional treatment cannot address, and offers him an experimental drug regimen with long odds.

He tells almost nobody. He drifts back to the small clubs where he started, and hires Ira Wright, a struggling young comic, as his joke writer and only real confidant. He uses the diagnosis as leverage to re-enter the life of Laura, the ex-fiancée he cheated on, now married with two daughters.

Then his doctor tells him the experimental treatment has worked.

Spoilers below. Almost everything useful about Funny People happens after George Simmons stops dying, so this page discusses the whole film.

The film gets its good news in one scene and moves on. NCI takes more care over the distinction, and the difference is the reason follow-up exists.

Remission, in NCI's definition, is a decrease in or disappearance of the signs and symptoms of cancer. It comes in two grades. In partial remission, some but not all of them have gone. In complete remission, all of them have gone — although, as NCI adds in the same breath, cancer may still be in the body.

Cure is defined differently. NCI says cure means there are no traces of your cancer after treatment and the cancer will never come back. That is a much stronger claim, and NCI is honest that doctors cannot usually make it. Some cells can remain for years. The most a doctor can say, in NCI's phrasing, is that there are no signs of cancer at this time.

Remission and cure goes further into how the two words get used.

After his good news, George never sits in a scanner again. In life that is where a large part of the experience lives.

NCI explains the reason for the monitoring plainly. Cancer cells can remain in the body for many years after treatment, and they may cause the cancer to come back. Most cancers that return do so within the first five years, though a later return is possible. So doctors keep watching, with tests, for years. They are also watching for late effects of the treatment itself.

NCI adds one detail that softens the word "cure" a little further. If you stay in complete remission for five years or more, some doctors may say you are cured. That is a convention, not a guarantee, and NCI says so.

The fear that follow-up appointments stir up is one of the most common and least discussed parts of life after treatment. The film shows none of it.

George is given a prognosis as though it were a fact about him. NCI describes it as something much softer: an educated guess, made by a doctor who cannot be certain how things will go for you.

It also sets out what goes into that guess: the type of cancer and where it is, the stage, the grade, certain traits of the cancer cells such as genetic changes or hormone receptor status, your age and health beforehand, and how you respond to treatment.

The statistics underneath are worth knowing by name, because they measure different things. Cancer-specific survival counts people who have not died of that cancer. Relative survival compares people with the cancer to people without it. Overall survival counts deaths from any cause. Disease-free survival counts people with no signs of cancer after treatment.

And NCI adds the caveat that matters most to anyone reading a percentage about themselves. Statistics come from large groups and cannot predict what will happen to you. It takes years to see the benefit of new treatments, so the figures your doctor is working from may not be based on the treatments used today. What a five-year survival rate actually means unpacks that.

Most cancer stories are about dying. This one is about the awkwardness of not.

George comes out of remission essentially unchanged. He pushes on with wrecking Laura's marriage, is rejected, and turns on Ira. Everyone who had already begun grieving him is left holding it. The film ends with a diminished, still-selfish man and a tentative reconciliation over writing jokes.

That is the insight worth keeping, and almost nothing else on screen is medically useful. George tours, performs and drinks with very little sign of the daily grind of an aggressive blood cancer. The move from "nearly always fatal" to "in remission" happens as one line of good news, rather than as a process of tests and waiting.

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Funny People is a film about how little a reprieve changes a person. It is not a guide to leukemia, and it never decides which one it is about. What it gets right is that surviving is a beginning rather than an ending. That is the part most cancer stories leave out, and the part NCI spends the most words on.

• NCI — Understanding Cancer Prognosis
• NCI Dictionary of Cancer Terms — remission
• NCI — Leukemia, Patient Version

This page discusses Funny People 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].