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Are There Tears in Your Popcorn? What to Learn From <i>The Fault in Our Stars</i>

movie portrays the fault in our lives when challenged with illness, and the joy in our lives when these challenges are met.
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A 2014 movie phenomenon is The Fault in Our Stars. Released June 6, it cost only $12 million to make (that's low in Hollywood) and as of only 20 days later, by June 26 it had taken in $104 million, making it for a time the No. 1 box office hit in America, where it stayed in the top 10 for weeks. Why has it enjoyed such success?

When I went to see the movie on date night with my wife, we knew from the movie descriptions in the paper that it was about a teenage woman and teenage man, both of whom were facing cancer. About halfway into the movie, I was aware of sobbing behind me. And in front and on the side as well. Lots of tissues were being used. This did not surprise me at all, since my eyes were wet and teary, as were my wife's. If we were still snacking on our popcorn, there would have been tears as well as butter in it. How has this film touched so many movie viewers?

The movie is a screen adaptation of the popular book of the same title written by John Green. The inspiration for the book came from the author's first hand experience as a student chaplain at a children's hospital and his personal inspiration by a young woman dying of thyroid cancer. As of early June 2014, it had sold 10.6 million copies. It was No. 1 on the New York Times bestseller list (for children's chapter books) as well as Wall Street Journal,, and Barnes and Noble. It was wildly popular with young adult readers, who have turned out in droves to see the film.

As a film, superbly written by the team of Scott Neustadter and Michael H. Weber, the direction by Josh Boone was directly targeted to our hearts. It worked so well because the stars seemed so genuine, both Shailene Woodley (from The Descendents) as Hazel and Ansel Elgort (from Carrie) as Gus. They had worked together before, but this was the first time in this type of relationship.

The book and the film appeal to people because they show the problems that patients face while undergoing treatments, and the unpredictability of life's outcomes. Also (no spoilers here) it deals with the need for love and support, friends and family, and quality of life even in the face of disease symptoms. How this teenage couple deals with these issues is compelling and heart-warming. I was hooked.

In particular, oncologists have come to realize the unique challenges being faced by younger cancer patients. These differ from older patients since adolescent and young adult (AYA) patients face more difficulty with their physical and emotional roles, physical and social functioning, and fatigue. Worse, and as depicted so well in the film, unmarried young patients have much worse symptoms. There is considerable emphasis finally being paid to the important issues that AYA patients face and more progress is expected as more institutions focus new plans for controlling cancer in these patients.

What do we take home from the movie? What are my tips from this experience?

• Patients facing life-threatening illness need the support of family and friends. Too often patients feel abandoned since others seem uncomfortable around them. Frequently friends are watching their words lest they inadvertently use negative terms.

Support groups can be helpful, but one must beware that there can be depression, stress and anger when other members of the group relapse and even die.

• When choosing treatments, consider the importance of quality of life. This includes enjoying social relationships as well as family, especially for younger patients who are more sensitive to changes in friendships.

• Get support for controlling symptoms of the disease. If your physician is not controlling these symptoms adequately to allow a good quality of life, consider getting a consultation with other specialists who can be more effective. This might include pain specialists, physical therapists or physiatrists, psychiatrists or psychologists, or internists specializing in fatigue. Mind-body interactions may be important and using meditation, yoga, and progressive relaxation can help. If symptoms do not improve, get a second opinion when necessary. For advice on when and how to get a second opinion, see my book Surviving American Medicine.

• If the patient is a young adult, make sure you have researched the unique websites available for AYAs, adolescent and young adult patients, since there may be unique tips to help such people.

The Fault in Our Stars movie portrays the fault in our lives when challenged with illness, and the joy in our lives when these challenges are met.

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