The Professor (2018) and Stage IV Lung Cancer

Richard Brown teaches literature at a comfortable New England college. At a routine appointment he is told he has stage IV lung cancer. Roughly eighteen months if he starts treatment now. About six if he does not.

He declines treatment and tells nobody. That same evening his wife Veronica admits an affair with the dean. Soon after, his daughter Olivia comes out to him. Instead of falling apart, Richard begins dismantling the life he has been performing. He empties his seminar of students who are not genuinely interested. He drinks and smokes openly. He teaches with a recklessness colleagues read as a breakdown.

He confides in his best friend Peter, then in Olivia. Finally he announces the diagnosis at a faculty dinner, in front of the dean. The film never shows him in a hospital bed. It ends with him driving away with his dog, off the road and into an open field.

Spoilers throughout. Richard's diagnosis and the film's deliberately open ending are both discussed here.

This is the thing the film gets right, and it is worth defending.

Richard turns down treatment because the extra months on offer are not months he wants. Adults can make that choice, and the film does not moralise about it.

It also captures how a terminal diagnosis is often felt first as social isolation rather than physical suffering. The urge to protect other people by not telling them. The awkward etiquette of when to say it. The fear of being turned into a patient by everyone who knows. When he finally tells Olivia, she is angrier about being kept out than about the illness, which is how families really take this news.

Declining anti-cancer treatment is not the same as declining care, and the film blurs the two.

There is no oncology follow-up, no palliative care team, no symptom management at all. NCI describes palliative care as care to improve quality of life in serious illness, which can be given with or without treatment aimed at curing, to anyone at any stage. NCI says it can be given at any point from diagnosis to the end of life, and that people can ask their oncologist for a referral.

The other omission is his body. Richard stays articulate, mobile and physically unmarked for the whole film. Real illness often looks different, and every person's course is their own. NCI lists breathing trouble, chest pain, weight loss and fatigue among lung cancer symptoms.

NCI is blunt that sometimes lung cancer causes no signs or symptoms at all, and is found on a chest X-ray done for another reason. Because of this, it can go unnoticed.

When symptoms do appear, NCI lists these:

• Chest discomfort or pain.
• A cough that does not go away, or gets worse over time.
• Trouble breathing.
• Wheezing.
• Blood in the sputum a person coughs up.
• Hoarseness.
• Loss of appetite.
• Weight loss for no known reason.
• Fatigue.
• Trouble swallowing.
• Swelling in the face, or in the veins of the neck.

NCI advises checking with your doctor if you have any of these, because they can also have other causes. If you cough up blood, get medical care right away. Call 911 if the bleeding is heavy or you struggle to breathe.

Lung cancer does have a screening test, and the recommendation is based on age and smoking history.

The US Preventive Services Task Force gives a grade B recommendation for annual screening with low-dose computed tomography in adults aged 50 to 80 with a 20 pack-year smoking history. It applies to people who currently smoke or quit within the past 15 years.

A pack-year is one pack a day for a year, so 20 pack-years is a pack a day for twenty years, or two packs a day for ten. The Task Force widened this in its 2021 update, lowering the starting age from 55 to 50 and the pack-year requirement from 30 to 20.

The Task Force says to stop screening once a person has not smoked for 15 years, or develops a health problem that greatly limits life expectancy or the ability to have curative lung surgery.

The film never mentions whether Richard smoked, and never mentions screening at all. That silence hides a real problem.

If you have never smoked, or you fall outside those criteria, the Task Force recommendation does not cover you. For that group, telling your doctor about symptoms is the way to get checked.

Nothing here is sponsored and nothing is for sale. If the low-dose CT criteria were news to you, you can help keep that explanation free to read. Support our work.

The Professor takes a real decision seriously, which is more than most films about terminal illness manage. What it misses is that refusing treatment is not refusing care.

Underneath it sits a screening test many people may not know about. Low-dose CT is recommended based on age and smoking history. It is a fair question to ask at your next appointment.

• https://www.cancer.gov/types/lung/patient/non-small-cell-lung-treatment-pdq
• https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
• https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet

This page discusses The Professor for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.