Alexa & Katie (2018): Leukemia in High School

Heather Wordham's Netflix sitcom starts on the first day of high school. Alexa Mendoza is already in treatment for leukemia, and her best friend Katie Cooper shaves her head so Alexa will not be the only bald girl in the year. Running four parts across three seasons, the show stays deliberately small: wigs that cost more than Katie's family can afford, a basketball tryout Alexa is not cleared for, a rumour about which of them actually has cancer, a winter formal she can only attend in a mask during a flu outbreak, weeks at home because her immune system is too low for school, and a Christmas when she finds her old hospital bag. Later she reaches her final treatment appointment and is deflated to learn it means moving to survivorship follow-up rather than being finished with hospitals. She meets Spencer, who has Hodgkin lymphoma, and finds supporting him through his own chemotherapy harder than she expected. The series ends with the two friends graduating, starting university and coming home for Thanksgiving.

Spoilers throughout. Discussing the cancer storyline means discussing how this ends.

For a family sitcom it gets an unusual amount right about the texture of treatment rather than the drama of it. Chemotherapy is long, boring and cumulative; hair loss matters enormously to a teenager; the implanted port and its flushing are shown; low neutrophils mean being sent home from school and missing the dance; a flu outbreak is a real danger rather than an inconvenience. It is honest that a paediatric leukemia protocol takes years, not weeks, and that the last treatment is not the end, since Alexa is upset to discover she still needs regular checks. It also captures the social cost accurately: the pity she despises, friends who overcorrect, a father who cannot cope with seeing her without hair, a younger sibling adjusting around it, and a best friend quietly carrying her own losses.

It is a sitcom and everything is softened. Alexa is rarely shown genuinely unwell, with no mouth ulcers, vomiting, steroid mood swings or febrile admissions, all of which are routine on real leukemia protocols. Her cancer is never staged, subtyped or given a treatment name, so the medicine is essentially decorative. Hospital stays are brief and cheerful, the family's finances appear untouched, and there is no relapse, no serious discussion of long-term side effects and no death in her own storyline. The recovery arc is smooth in a way few real families would recognise.

Leukemia is a cancer of the blood-forming tissue, and acute lymphoblastic leukemia is the commonest type in children and teenagers. There is no screening test for it and none is recommended; it is found when a child becomes unwell and is investigated. NCI lists signs including fever, easy bruising or bleeding, flat pinpoint dark-red spots under the skin called petechiae, tiredness and pallor, bone or joint pain, breathlessness, swollen lymph nodes in the neck, armpit, abdomen or groin, loss of appetite or weight, abdominal discomfort, and frequent infections or infections that will not clear. Individually these are ordinary childhood complaints; what should prompt a blood test is a cluster of them, or ones that persist or worsen. Treatment is combination chemotherapy given in phases, remission induction, then consolidation or intensification, then maintenance, with additional chemotherapy given into the spinal fluid to protect the central nervous system. Total duration is typically around two to three years, which is why a character can plausibly be in treatment for most of high school, and follow-up continues for years after the last dose.

A film is not a diagnosis, and a dramatised illness is not a guide to your own. What a story like this is genuinely good for is lowering the barrier to a conversation you might otherwise put off.

If something in your body has changed and stayed changed for a few weeks, that is worth raising with a doctor — not because it is likely to be cancer, but because most of the time it will not be, and finding that out is the point. Where screening exists for a cancer, it is the one thing you can do before anything is wrong at all. See screening and possible warning signs.

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Alexa & Katie is worth watching as a film. It is not a guide to the disease it portrays. The gap between the two is what this page is for — and the thing worth carrying away is that a change which persists is worth a conversation, whatever a story led you to expect.

This page describes a work of film or television 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].