The Leisure Seeker (2017): A Road Trip and a Diagnosis

Ella and John Spencer are an elderly Massachusetts couple. They slip away from their doctors and their two grown children in the battered camper van they christened the Leisure Seeker, driving the old coastal route toward Ernest Hemingway's house in Key West. John is a retired English teacher whose dementia is well advanced. Ella, wigged and in pain, is concealing how little time she has.

The trip is punctuated by their children's frantic phone calls, a roadside robbery, and a detour that reframes the marriage. John wanders off at a tourist site and ends up in a hospital, which is where Ella's own situation becomes unavoidable.

Spoilers below. This page discusses the choice Ella Spencer makes at the end of The Leisure Seeker, and the letter she leaves her children.

Ella's disease has no clinical content at all. She takes pills out of sight, vomits and explains it away, wears a wig, and keeps performing competence for a husband who mostly cannot notice. Press coverage of the film describes her illness only as terminal cancer, with no site named.

For the film, that is a defensible choice. It is not a story about a disease. It is a story about the arithmetic two old people do when both of them are failing in different directions, and it is honest that Ella's decision is driven as much by the impossibility of leaving John behind as by her own prognosis.

But a story that says nothing leaves a gap, and gaps get filled. So the useful thing this page can do is set out what a real description of an advanced cancer actually contains, because it is more specific than the word "terminal" suggests.

"It has spread" is one phrase covering several different situations. NCI describes the process as a sequence of steps, and the steps are worth reading slowly:

• growing into, or invading, nearby normal tissue
• moving through the walls of nearby lymph nodes or blood vessels
• travelling through the lymphatic system and the bloodstream to other parts of the body
• stopping in small blood vessels at a distant location, invading the vessel walls, and moving into the surrounding tissue
• growing in that tissue until a tiny tumour forms
• causing new blood vessels to grow, which gives the new tumour a blood supply

NCI adds a detail that changes how the whole thing feels. Most of the time, spreading cancer cells die somewhere along that route. And cells that do reach a distant site can stay inactive there for many years before growing, if they ever grow at all.

The routes are not the same thing. Cancer found in nearby lymph nodes is recorded one way. Cancer found in a distant organ is recorded another. NCI also notes where cancers usually land. The most common sites are bone, liver and lung, and each cancer has its own pattern. A colon cancer, for example, most often reaches the liver, the lung or the lining of the belly.

This is the rule the film's vagueness obscures, and it is the single most useful thing to carry out of this subject.

NCI states it plainly. Metastatic cancer has the same name as the primary cancer. Breast cancer that spreads to the lung is metastatic breast cancer, not lung cancer. It is treated as stage 4 breast cancer. For many cancers, "metastatic" and "stage 4" mean the same thing.

There is a reason the name survives the journey. Under a microscope, the cells look like the cancer they came from, not like the place they are found. NCI says that is how doctors work out where a cancer started. Sometimes they cannot. NCI has a name for that too: cancer of unknown primary origin.

So "where did it start?" is not a historical curiosity. It is the question that decides the treatment. Metastatic cancer covers this in full, and colorectal cancer is one worked example of a primary that keeps its name wherever it lands.

Ella manages an advanced cancer out of a handbag, for the length of the eastern seaboard, alone.

That is the film's largest omission, and it is the most fixable one in real life. NCI describes palliative care as care meant to improve quality of life in a serious illness. It can be given with or without treatment aimed at cure. NCI says anyone can receive it, at any age and any stage. It covers pain, fatigue, appetite, sickness, breathlessness and sleep. It covers the emotional side. And it covers carers, who NCI says are often overwhelmed by what falls to them.

Every one of those applies to a woman who is seriously ill while also being the sole carer for a husband with advanced dementia. Palliative care sets out how to ask for it.

What the film gets right is smaller and truer. Ella's letter tells her children in advance that they will feel relieved, and that they should not feel guilty about it. Families rarely say that out loud. The ending is a different matter. It is an act of authorship, not a picture of dying. A shared death, shown as calm and tidy, with none of the questions raised by choosing for a spouse who cannot agree to it.

Cancer Explained carries no advertising and sells nothing. If this page turned "it has spread" into three separate questions you can ask, you can help keep it free for the next reader. Support our work.

The Leisure Seeker is a road movie about two people running out of road, and it tells you nothing about the illness driving it. Take the plain version instead. Spread through the lymph and spread through the blood are different things, and a cancer keeps the name of where it started, wherever it ends up.

• NCI — Metastatic Cancer: When Cancer Spreads
• NCI — Palliative Care in Cancer

This page discusses The Leisure Seeker 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].