Cool Kids Don't Cry (Achtste-groepers huilen niet) (2012)

Akkie is eleven, in her final year of Dutch primary school, football-mad and quick to fight, particularly with Joep, a classmate she cannot stand. After a playground scrap she is taken ill and tests show leukaemia. Treatment pulls her out of school and into hospital; she loses her hair, is embarrassed by it, and is furious at being handled gently. Her teacher keeps a place for her in the class and she keeps insisting on being treated exactly as before. On the school camping trip she gets stuck up a tree and it is Joep who talks her down; the enmity turns into friendship and something like first love. Then the disease comes back and spreads to her brain. She cannot play in the school football tournament she has been aiming at, so her classmates bring the match to her, playing where she can watch from her hospital bed. She dies watching them, and the team plays the tournament with her name on their shirts.

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

For a children's film it is unusually unsentimental about what a class does with news like this: the awkwardness, the whispering, the teacher who has to explain something he cannot explain to himself, the friends who overcompensate and the ones who quietly avoid her. Akkie's own anger at being treated as fragile is the truest note in it, and matches how many school-age patients describe the experience. The physical details of treatment, hair loss, the line, isolation, exhaustion, the cycle of feeling better then worse, are shown rather than implied. The relapse arrives without warning, which is how relapse usually arrives, and spread to the central nervous system is a real complication of leukaemia. The film also lets adults be visibly frightened in front of children.

The timeline is compressed hard: diagnosis, remission, relapse, brain involvement and death all fall inside a single school year, and treatment that in reality runs to years of chemotherapy is reduced to a few montages. Akkie's deterioration is largely confined to tiredness and hair loss; the headaches, vomiting, seizures and neurological changes that central nervous system disease usually brings are softened almost entirely away. She is lucid, funny and comfortable in her final scene. The film also skips the long maintenance phase and the endless clinic visits, which is what childhood leukaemia mostly consists of day to day.

The film says only 'leukaemia'; in a child of eleven the commonest form is acute lymphoblastic leukaemia. It begins in the bone marrow, where abnormal immature white cells build up and displace healthy blood cells. NCI's list of signs in children is fever, easy bruising or bleeding, petechiae (flat pinpoint dark-red spots under the skin), tiredness or weakness, pale skin, bone or joint pain, which in younger children can look like limping or refusing to walk, shortness of breath, swollen glands in the neck, armpit, abdomen or groin, painless swelling or fullness below the ribs, loss of appetite and weight, and infections that keep returning. Parents are advised to see a doctor about symptoms that persist rather than to look for one dramatic sign. Diagnosis uses a full blood count with differential, a blood smear, and a bone marrow aspirate and biopsy; a lumbar puncture examines the spinal fluid, because leukaemia reaching the central nervous system, as it does in this film, changes treatment. No screening test exists for childhood leukaemia and no health body recommends screening well children for it.

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.

Cancer Explained is free and ad-free. Nothing is sold on this page and no sponsor sits behind it.

If this helped you understand something, or moved you to ask a question you had been avoiding, you can help keep clear cancer information free for whoever needs it next. Support our work.

Cool Kids Don't Cry 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].