Ken Burns tackles history of cancer

Liz Szabo | USA TODAY

Ken Burns' new documentary, Cancer: The Emperor of All Maladies, marks a contrast to the historical documentaries for which he's best known. Unlike the Civil War or the Roosevelt presidencies, the story of cancer doesn't yet have an ending.

Burns, the film's executive producer, says his approach changed as he learned more about the history of cancer research, and the challenges facing doctors and patients today.

"When we first started talking about it, we had this unbelievable optimism that we were on this cusp" of a new era, Burns says. Over time, "we began to realize how many times people had said, 'The cure is around the corner.'"

The three-part PBS documentary (Monday, 9 p.m. ET/PT, check local listings), opens with a parade of presidents — Lyndon Johnson, Richard Nixon, Bill Clinton and George W. Bush — predicting imminent progress against cancer.

Yet as the film notes, initial excitement about promising discoveries often gives way to the sinking realization that cancer is vastly more complicated than even top scientists had realized.

"Science is a profession for manic-depressives," says scientist Robert Weinberg, whose lab discovered the first human cancer genes, in the film. "There (are) occasional highs where we make a discovery, and 90 to 95% of the time, there's frustrating difficulties or nothing happens."

Cancer patients often experience the same sort of highs and lows during their therapies. Along with the history and science of cancer, the film weaves the stories of contemporary patients as they endure punishing treatments or wrestle with life-changing decisions. One woman with breast cancer, a cancer surgeon from Howard University Hospital in Washington, D.C., allows cameras in the operating room during her double mastectomy.

The filmmakers spent months with patients, not knowing if they would survive. Not all did.

"It was important to all of us not to shy away from the ugliness of cancer and the toll it takes," says director Barak Goodman..

The interviews illuminate the choices made by patients and doctors. In the 1940s, parents of children with leukemia had to decide whether to allow their children to join clinical trials of the first chemotherapies, led by a pioneering Boston doctor named Sidney Farber.

Farber knew that his medicines were forms of poison, but he balanced their risks with the knowledge that his young patients faced certain death from leukemia, Goodman says.

The story of cancer isn't a steady, inevitable climb toward a cure, but one of "zigzags and failures and intuition and guesswork and luck," Goodman says. "There is this temptation to see these ups and downs as a zero-sum game, and you're back where you started. But every time we fail, we get closer and we learn from it."

Today, doctors can cure 80% of childhood cancers, says oncologist Siddhartha Mukherjee, whose Pulitzer Prize-winning book, The Emperor of All Maladies, is the basis for the film. Overall, cancer mortality rates for people of all ages have declined 20% over the past two decades.

Yet therapies for the most aggressive kinds of pediatric leukemia can leave children with brain damage. The filmmakers follow the family of 14-month-old Olivia Blair as they wrestle with whether to subject her to such risky therapy. Her parents pray over what to do.

Sometimes, the side effects of cancer treatment can be life-threatening.

The filmmakers spent months with Luca Assante, whose treatment for a muscle tumor caused him to develop an even more aggressive cancer of the blood. He died during the film's production at age 6.

"Luca's death was totally unexpected, even among his own doctors," Goodman says. "Even the greatest doctors in the world … don't always have the answers and are sometimes taken aback by this disease."

Yet Goodman says the film is not entirely grim. Viewers also get to see patients whose cancers go into remission after treatment.

The film, Goodman says, is "a good-news story. Where we end up after the three episodes and six hours is a place of a lot of hope, and hard-won hope — hope that has come at the cost of a lot of lives."