Clouds (2020) and Relapsed Osteosarcoma

Zach Sobiech is a Minnesota high school senior who has been living with osteosarcoma since he was fourteen. As the film opens he learns that treatment has stopped working and that he has months left — his family is told roughly six to ten. Zach decides to spend that time making music. With his best friend Sammy Brown he forms the duo A Firm Handshake, plays local shows, and writes a song called 'Clouds' about his own dying. His mother Laura films the recording; the video goes online and spreads far beyond Minnesota, drawing national attention and money for osteosarcoma research. Alongside this he has a first serious relationship with Amy, finishes school, and writes a college essay about how he wants to be remembered. The film does not fake a recovery. Zach's health declines and he dies on 20 May 2013, aged eighteen. In an epilogue his friends and family gather and see a cloud shaped like a Z.

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

Made with the Sobiech family's participation and based on Laura Sobiech's memoir, this is one of the more careful cancer films. It gets the shape of a paediatric bone cancer right: diagnosis in the early teens, years of surgery and chemotherapy, remission, relapse, and then the point at which treatment is stopped because it is no longer helping. It shows crutches, a limp, mobility loss and the physical cost of surgery rather than an invisible illness. It is honest about the specific cruelty of adolescent cancer — missing school, watching friends move on, negotiating a first relationship while dying — and about the moment a family is told curative treatment is over. The lead actor wore Zach's actual clothes and crutches. The song and the research fundraising it generated are real.

The film gives Zach considerably more energy and stamina than late-stage metastatic osteosarcoma usually allows, especially in the performance scenes; breathlessness from lung metastases and pain from bone disease are underplayed. It also compresses nine years of illness into a single senior year, so the grinding repetition of scans, operations and chemotherapy cycles — Zach had ten surgeries and twenty-four rounds of chemotherapy in real life — is largely off screen. And the viral success is exceptional, not typical: most young people with terminal cancer do not get a public legacy, and the film's uplift risks implying that meaning is something a dying person must achieve.

Osteosarcoma is the most common cancer that starts in bone, and it mainly affects adolescents and young adults during the growth spurt. NCI notes roughly 440 cases a year in people aged 19 or under in the United States. More than half occur in the long bones near the knee — the lower thigh bone or upper shin — and it also appears in the long bones of the arm. Zach Sobiech's began in his left hip, which is less usual.

The early signs are easy to dismiss as sports injury or growing pains: pain in a bone or joint that persists, swelling or a lump over a bone or bony part of the body, pain in the arm when lifting, joint stiffness or difficulty moving, a limp, and occasionally a fracture from a minor knock. Bone pain that continues for weeks, or that wakes a child at night, deserves a doctor's assessment and usually an X-ray.

There is no screening test for osteosarcoma, and none is recommended for anyone, including children. Diagnosis starts with an X-ray, followed by MRI or CT and a biopsy for confirmation. Because there is no screening, the whole burden of earlier detection falls on taking persistent bone pain seriously.

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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Clouds 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].