How Watching the Movie Zombieland Helps Treatment of Cancer in Teenagers

Abstract

The paper describes a challenging clinical encounter with an adolescent undergoing treatment for cancer. Undeniably, oncologists have a very challenging job. It requires more than simply diagnosing and treating cancer by giving chemotherapy and checking blood counts. The challenges they face are increased when caring for a teenager with cancer. Providing opportunities for these young patients to be involved in their own treatment and motivating them in tough times are crucial. Communication is the foremost way to keep all doors open in this unique physician–patient relationship. One such approach is “movie therapy” using characters and actions as metaphors for describing cancer and cancer treatment.

“Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.”

Voltaire (François-Marie Arouet) French Enlightenment writer and philosopher, 1694–1778

Chuck, a 15-year-old patient of mine with relapsed Ewing sarcoma, is very bright and smart, and even with his ongoing chemotherapy, he seems to be very energetic. He very much behaves like the usual teenager in that he is tough to talk to and “difficult” for his parents to handle. He has received only outpatient treatment and has not experienced hair loss. His life is as close to normal as possible. At each visit to our clinic, he poses many questions regarding his condition, and answering his questions is always difficult.

In one visit to our clinic for a physical examination and blood count check, we had a discussion about his future treatments. His tumor was having a mixed response to the current therapy, with several metastases in the lung. We had decided to resect the lesions to identify the responding and nonresponding lesions. On that visit, he asked me, “Why do I need surgery in addition to all the stuff I am getting? Does it mean what you are giving me is just a sugar pill by mouth or salt water into my vein? What will happen if I don’t go for surgery? Why can’t you do it today here?”

I explained to him that the nonresponding tumors had to be removed and that only those “folks who wield the knives and scalpel” (surgeons) are capable of doing so. I also gave him some scientific articles on “local control (surgery) in Ewing’s sarcoma and how surgery helps in treatment of all solid tumors” that I identified in searches of the PubMed database and Google. Although his parents agreed that he should undergo the surgery, Chuck remained unsatisfied with my answers while I awaited discussion with my supervising attending physician to staff and precept Chuck’s visit. My professor, who is renowned for treatment of this deadly bone cancer and is famous among teenagers for his appearance in The Art of the Possible, a film about the lives of five young individuals diagnosed with bone sarcomas, walked into the patient room and asked Chuck, “Have you watched the movie Zombieland?” Chuck said that he had seen it and seemed to be excited and listening intently to the senior professor who then said, “Treating your cancer is like killing those zombies.”

The professor advised following two rules created by the central character in movie. “Rule #1: cardio. You’ve got to keep yourself fit first before you can fight cancer. Make sure you eat healthy, do breathing exercises, and go for physical therapy. Rule #2: double-tap. Cancer, like zombies, needs a double-tap to make sure you kill it. You need chemo, which is one tap, and surgery, another tap, to kill it.” Chuck was happy with this explanation and agreed to undergo the surgery. We then scheduled the surgery consultation.

After this episode, I was left wondering about how simple the professor’s answers to Chuck’s questions were whereas I struggled to satisfactorily answer them based on scientific articles and logical reasoning. As a fellow in training in oncology, I frequently encounter such questions from teens with cancer. I have found it relatively easy to answer questions from parents regarding young children (i.e., those who still listen to their parents; dogmatic tough statement—I may be biased) and from adults who come to our major cancer center for therapy and respect oncologists’ decisions. In comparison, answering seemingly random questions from teenagers and young adults like Chuck is a real challenge.

On the weekend this discussion with Chuck took place, I rented and watched Zombieland. This American comedy film, released in 2009, is set in a postapocalyptic era 2 months after a fictional mutated strain of mad cow disease (bovine spongiform encephalopathy) turns nearly all humans into zombies. In it, a group of individuals led by a college student named Columbus eliminate the zombies. A running gag and central theme throughout the film is a list of rules Columbus comes up with for surviving in the zombie-infested world. By the end of the film, his list consists of 33 rules like the ones my professor mentioned to Chuck at his clinic visit.

What is a zombie? An animated corpse that feeds on human flesh and is controlled via magic or voodoo. What is a double-tap? A shooting technique in which two well-aimed shots are fired at the same target with very little time in between. The term hammer is sometimes used to describe a double-tap in which the firearm’s sights are not resighted by the shooter between shots. For Chuck, cancer is the zombie and cancer treatment is the double-tap. Other, more prominent rules in the movie, like “enjoy the little things” and “hygiene,” also apply to cancer. The movie’s witty use of dialogue and popular culture was useful in connecting with Chuck, and I have since used this analogy successfully with many of my young patients.

Bob, another of my patients who is 18 years old, brought me a book on how to survive a zombie attack. His advice to me was, “Hey doc, read this book and perhaps you can try this on cancer one day and kill it.” The title of the book, which was written by Max Brooks, is The Zombie Survival Guide: Complete Protection from the Living Dead. The back cover of the book lists the top ten lessons for surviving a zombie attack, which are presented below.

1. Organize before they rise!

2. They feel no fear, why should you?

3. Use your head: cut off theirs.

4. Blades don’t need reloading.

5. Ideal protection = tight clothes, short hair.

6. Get up the staircase, and then destroy it.

7. Get out of the car, get onto the bike.

8. Keep moving, keep low, keep quiet, and keep alert!

9. No place is safe, only safer.

10. The zombie may be gone, but the threat lives on.

Undeniably, oncologists have a very challenging job. It requires more than simply diagnosing and treating cancer by giving chemotherapy and checking blood counts. The challenges they face are increased when caring for a teenager with cancer. Although cancer is rare in teenagers, it does occur. Teenagers in high school or college usually wish to be independent. A cancer diagnosis adds a major obstacle to independence in this already turbulent period. These individuals who want to be free, independent decision makers find themselves with their parents still making decisions for them because of their cancer diagnoses. Providing opportunities for these young patients to be involved in their own treatment and motivating them in tough times are crucial. Communication is the foremost way to keep all doors open in this unique physician–patient relationship.

Most parents of teenagers almost always feel that having conversations with their children is impossible. Teenagers are not an extraterrestrial species—they are just growing up. However, they want to continue having conversations with their parents. Oncologists treating cancer in this population must learn this art by incorporating more “door openers” than “door slammers” as communication tools so that they and their patients can learn from each other. After the encounters with these young patients, I asked around my colleagues and more young patients so I can compile a list of movies (Table 1) with healthful cancer-fighting messages for our future patients and health care providers to derive inspiration from. Although I haven’t had the time to watch all those movies, I wanted to share this list for the benefit of future patients. Some may have a direct message, some comedies/feel-good movies to uplift the mood, and some of them indirectly like the Zombieland movie using characters and actions as metaphors for describing cancer and cancer treatment.

Table 1.

List of 50 movies that may benefit cancer patients and healthcare providers

	Movie title	Message/story line
1	My life without me	A mother records tapes of advice for every birthday her daughters will have growing up without her
2	Farrah’s story	Faith, courage, hope, and positive thinking
3	The terry fox story	A courageous man young cancer activist and marathon runner’s inspiring story
4	Life as a house	A “tearjerker” about a man who repairs after diagnosed with terminal cancer
5	My sister’s keeper	Terminal childhood cancer
6	A walk to remember	Based on a novel by Nicholas Sparks
7	The doctor	This is an adaptation of Ed Rosenbaum’s memoir “A Taste of My Own Medicine,”
8	Stepmom	On adjustment. A terminally ill mother has to settle on the new woman in her ex-husband’s life, who will be their new stepmother.
9	The doctor	Story about a doctor re-examining life after getting diagnosed with cancer
10	Stand and deliver	Determination, prejudice, overcoming the odds, power of education, belief in self
11	Evelyn	Overcoming adversity, taking on the legal system, love, hope
12	Crazy sexy cancer	Uplifting documentary about a young woman looking for a cure and finding her life
13	Bucket list	Two terminally ill men escape from a cancer ward and head off on a road trip with a wish list of to-dos before they die
14	Life is beautiful	Love between a father and son, the magic of love, the power of positive thinking, and surviving unspeakable horrors
15	A greater yes	It’s a movie about a young girl who develops cancer and her struggles
16	Terms of endearment	Sad movie, but a favorite among cancer survivors
17	Erin Brockovich	Waging a war against a company.
18	127 hours	A mountain climber becomes trapped under a boulder while canyoneering alone and resorts to desperate measures in order to survive
19	The kite runner	A story of friendship, hope, gratitude, and survival beginning in Afghanistan pre-Taliban and ending in modern-day San Francisco
20	Dying young	Falling in love with a young man suffering from blood cancer
21	Good Will Hunting	Will Hunting, a janitor at MIT, has a gift for mathematics but needs help from a psychologist to find direction in his life
22	Marvin’s room	A leukemia patient attempts to end a 20-year feud with her sister to get her bone marrow
23	Norma Rae	Breaking through the status quo
24	Steel magnolias	A close-knit circle of friends whose lives come together there
25	It’s a wonderful life	The quintessential feel-good movie of all time
26	Chariots of fire	True story of two young athletes who ran for Great Britain in the 1924 Paris Olympics
27	Cinderella man	A washed-up boxer who came back to become a champion and an inspiration in the 1930s
28	Gandhi	Biography of Mahatma Gandhi. Strong messages including dealing with prejudice, determination, overcoming the odds, friendship, and life lessons
29	World’s fastest Indian	You are never too old to follow your dreams as this inspiring true story of New Zealander Burt Munro makes clear
30	Ray	Despite blindness, talented musician carves out an amazing career
31	The sound of music	The opening line “The Hills are Alive with the Sound of Music” alone is enough to fill anyone with inspiration.
32	Mr. Holland’s opus	This is a story for anyone who has had to postpone his/her dreams because life gets in the way.
33	The pursuit of happyness	Homelessness, financial struggle, overcoming the odds, humility, gratitude, and fatherhood
34	Rudy	Based on a true story, Rudy shows that it is not the attainment of the goal that provides the satisfaction but surviving and growing through the journey which is the ultimate reward.
35	Frequency	An accidental cross-time radio link connects father and son across 30 years. The son tries to save his father’s life, but then must fix the consequences.
36	Garbage picking field goal kicking Philadelphia phenomenon	A Philadelphia garbageman who develops his leg muscles from kicking the hydraulic lever on his truck is discovered by the Philadelphia Eagles and signed by them to become a kicker.
37	Don’t tell her it’s me	Comedy about what comes after recovery from cancer
38	A Christmas romance	Two people are about to discover that what they need most is each other
39	A message from Holly	A high-powered, workaholic executive who takes time off from her work to live with her friend Holly, who reveals she has terminal cancer which leaves her with only 6 months left to live
40	The Blind side	A homeless, traumatized boy who became an All American football player
41	Wit	A renowned professor is forced to reassess her life when she is diagnosed with terminal ovarian cancer
42	Ikiru (1952)	Akira Kurosawa’s movie
43	Funny people	Funny movie of a standup comedian who has terminal illness
44	Cries and whispers	Ingmar Bergman’s supremely painful 1972 masterpiece
45	The shawshank redemption	Two imprisoned men bond over a number of years, finding solace and eventual redemption through acts of common decency
46	Brian’s song	Based on the real-life relationship between teammates
47	Remember the Titans	The true story of a newly appointed African-American coach and his high school team on their first season as a racially integrated unit
48	October sky	Surviving parent’s disapproval, hope, and perseverance
49	Man on the moon	A film about the life and career of the eccentric avant-garde comedian, Andy Kaufman
50	Rocky	Determination, overcoming the odds, friendship, and life lessons

These movies may have a direct message, some comedies/feel-good movies to uplift the mood, or using characters and actions as metaphors for describing cancer and cancer treatment

As in life and my oncologic training, every day is a learning experience, and Voltaire’s statement from the seventeenth century holds true today. Chuck and Bob have taught me lessons in the art of oncology practice in teenagers. The rules and principles for surviving a zombie attack may eventually be applicable in the war against cancer.

At the end of Zombieland, Columbus states that “a little sunscreen never hurt anybody.” I also learned that Chuck always makes his family members and friends wear sunscreen.