Truman (2015) and Advanced Lung Cancer

Julián is an Argentine actor living in Madrid who has been treated for cancer for about a year. His oldest friend Tomás flies in from Canada for four days without warning, and Julián immediately guesses why. Rather than argue, Julián tells him plainly that he is stopping treatment: more chemotherapy would only postpone the inevitable, and if his health collapses he intends to end his life on his own terms. He would rather spend what is left arranging matters. Those matters are mostly small and mostly about his ageing boxer dog, Truman — who will take him, whether the dog will grieve, whether the new owner is good enough. He also settles his own funeral arrangements and stops working. His cousin Paula, who has carried much of the load, is furious that he has given up and cannot bring herself to say so. He and Tomás fly to Amsterdam to see his son Nico, and Julián does not tell him he is dying. Back in Madrid, Tomás takes Truman home to Canada. The film ends on the goodbye; Julián's death is offscreen and certain.

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

The film is unusually good on the social awkwardness of terminal illness — people crossing the street to avoid him, acquaintances who cannot find a sentence, and the sick person doing the emotional labour of reassuring everybody else. It takes seriously that declining further treatment can be a considered choice rather than despair, and that oncologists do sometimes say honestly that more chemotherapy buys weeks, not years. The practical business of dying is well observed: paperwork, funeral arrangements, deciding who gets what, and the disproportionate weight of a pet's future. Paula's anger is realistic too — families frequently experience a patient's decision to stop treatment as abandonment. And it is honest that the decision is Julián's to make, however much it costs the people around him.

A radiation oncologist reviewing the film flagged the obvious licence: Julián has advanced lung cancer and yet shows no cough, no breathlessness, no pain, no weight loss and no fatigue. He eats well, drinks, travels to Amsterdam and looks healthy throughout. Real advanced lung cancer at the point where treatment is being abandoned usually involves at least some of those, plus symptom-control medication the film never shows. The neat four-day window also lets him complete every arrangement, which real illness rarely permits. Assisted dying is discussed as an available option, but it was not legal in Spain when the film was made — that only changed in 2021.

Lung cancer often causes nothing early on, and NCI notes it is sometimes found on a chest X-ray done for something else entirely. When symptoms do come, NCI lists a cough that does not go away or gets worse, chest discomfort or pain, breathing difficulty, wheezing, blood in the sputum, hoarseness, loss of appetite, unexplained weight loss, fatigue, trouble swallowing, and swelling of the face or of the veins in the neck. Screening exists, but only for people at high risk from smoking: the USPSTF recommends annual low-dose CT scanning for adults aged 50 to 80 who have a 20 pack-year smoking history and who currently smoke or quit within the past 15 years (grade B). There is no recommended lung cancer screening for anyone outside that group, including lifelong non-smokers — worth stating plainly, because a meaningful share of lung cancers occur in people who never smoked, and those are found only once symptoms appear. A cough lasting more than about three weeks, or coughing up any blood at all, should be assessed rather than waited out.

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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Truman 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].