‘Brian’s Song’ at 50 still offers lessons about cancer for today

When “Brian’s Song” made its debut as an ABC Movie of the Week in 1971, this tear-jerker about a professional football player who died of cancer became a surprisingly popular hit.

Fifty years later, it has sunk into obscurity, along with “Brian Piccolo: A Short Season,” a book written by Jeannie Morris, a journalist and wife of Johnny Morris, one of Piccolo’s teammates.

But I think it is worth remembering these dual versions of Piccolo’s cancer. “Brian’s Song” painted a gauzy, almost sanitized version of his illness and death — the kind of storytelling we see less often today. Morris’s book was far more frank, a harbinger of greater openness about cancer to come over the succeeding decades.

Despite being 50 years old, both the movie and book raise issues that are highly relevant for people diagnosed with cancer today and their families.

Piccolo was a running back with the Chicago Bears. In the fall of 1969, he developed a severe cough and shortness of breath. To everyone’s surprise, doctors found a grapefruit-sized tumor in his mediastinum, an area of the chest behind the sternum. The ultimate diagnosis was embryonal cell carcinoma, a rare type of testicular cancer.

Piccolo underwent treatment at New York’s Memorial Sloan-Kettering Cancer Center where, in November 1969, surgeons removed the tumor and part of his lung, where the cancer had also spread. Because his doctors also found a nearby lymph node that was positive for cancer, Piccolo also underwent chemotherapy.

Piccolo’s surgeon, who had been a college football player, was a Bears fan and bonded strongly with his patient. He declared the operation a success. Piccolo told friends he had “been blessed and was cured of cancer.”

Unfortunately, that was wishful thinking. Four months later, the cancer had recurred in Piccolo’s chest wall. When more chemotherapy did not help, his surgeons performed a radical mastectomy, a highly disfiguring operation normally used to treat for breast cancer. Two weeks later, doctors took out the rest of Piccolo’s diseased lung, but during the operation found more cancer they could not remove. Next came cobalt treatment, a type of radiotherapy, which Piccolo completed in May. But nothing helped. He died at age 26 in June 1970.

“Brian’s Song” emerged from an autobiography, “I Am Third,” by Piccolo’s teammate and star running back Gale Sayers, which was published soon after Piccolo died and contained a chapter on his relationship with Piccolo. Sayers, who was Black, and Piccolo, who was white, were the first interracial roommates on the Bears. The terse Sayers grew to love the loquacious Piccolo, and Sayers was deeply saddened when his teammate became ill.

“Brian’s Song,” which aired November 30, 1971, was an instant hit, becoming the fourth most-watched made for television movie at the time. The fact that two future Hollywood stars, James Caan and Billie Dee Williams, played Piccolo and Sayers, respectively, helped, as did Michel Legrand’s affecting score. But the tragic story of a young athlete dying of cancer, in an era when discussing cancer openly was still often taboo, moved audiences. The film had the reputation of being the one film at which men were “allowed to cry.”

Yet while the film definitely depicts Piccolo’s terminal illness, it did so in a sanitized way. As Piccolo gradually deteriorates, he is “stiff upper lip,” cracking jokes and following doctors’ orders rather than expressing any anger or frustration. Caan looks the same at the beginning and the end of the movie, sporting a full head of curly hair. And when Piccolo’s wife Joy, played by Shelley Fabares, takes Piccolo’s hand shortly before he dies, Piccolo smiles and placidly says of his cancer, “Who’d believe it, Joy — who’d ever believe it?”

Jeannie Morris’s book, while hardly an expose, painted a different picture. Piccolo’s second operation, the radical mastectomy, had been devastating both physically and emotionally. Her friend, Morris reported, felt “very frustrated” and “extremely mutilated.” Toward the end of his illness, Piccolo, feeling “simply drained — of everything,” rarely left his home. He also experienced constant facial pain because the tumor had infiltrated his jaws and teeth. And even as Piccolo was dying, doctors “wheeled, poked, turned, punctured [and] manipulated” him.

According to Morris, it was “torture.”

Why are the movie and book so relevant? We are still dealing with the challenging issues that Brian Piccolo’s illness and death raised: How hard should you push with aggressive cancer treatment, especially when the person is young and unlikely to survive? And when does too much optimism become a bad thing?

How hard should you push? Remarkable advances have been made in cancer care since Brian Piccolo died but thousands of people — including young people — still die from the disease each year. One of the saddest aspects of Piccolo’s story is that his last months were largely miserable as his doctors kept treating him with toxic, but ultimately, futile, therapies. This still happens.

Fortunately, palliative care services have emerged to work with dying people and their families to establish treatment goals and provide symptomatic relief. Palliative care may even extend life.

How optimistic should we be? Studies consistently show that doctors may be too optimistic with their cancer patients. While stressing hope, especially soon after diagnosis, is understandable and can help motivate patients, health professionals need to be frank when treatments prove less successful than hoped. One suspects that Brian Piccolo knew he was dying, but his doctors lacked the courage to tell him so.

Today’s cancer specialists are trained not just to treat cancer but also to acknowledge the potential limits and harms of therapies. Still, cancer patients and their families, working with their caregivers, should do everything possible to avoid the unfortunate choices that characterized Brian Piccolo’s final days.

Barron H. Lerner is a professor of medicine and population health at New York University Langone Health and the author of “When Illness Goes Public: Celebrity Patients and How We Look at Medicine” (Johns Hopkins University Press, 2006).

Editor’s note: This article was updated to correct the name of the actress who played Brian Piccolo’s wife, Joy, in “Brian’s Song.”