Watching Jen, a bright-eyed 7-year-old with chemo-induced thinning hair, her face reddened from tears, lying on her side as a doctor prepares to perform a spinal tap, the agony of her anticipation is wrenching. She knows all too well what is coming. As she recounted in the hallway on her way to the procedure, she has already had eight spinal taps since her leukemia treatment began.

The scene takes up just a few minutes of the approximately 500 hours of footage that two Dayton, Ohio-based filmmakers, Julia Reichert and Steven Bognar, are turning into a 6-hour documentary titled A Lion in the House, which follows 5 children with cancer and their families over 6 years. A 30-minute segment of the film was shown on the NIH campus last week as part of a lecture series sponsored by NCI's Center to Reduce Cancer Health Disparities (CRCHD). A wide-ranging documentary, A Lion in the House offers a first-hand glimpse at the barriers and difficulties faced by cancer patients who are poor or from underserved communities. Tim, a 15-year-old African American being treated for Hodgkin's lymphoma, for example, can't maintain his weight. It's not that the treatment isn't going well: He lives in a small apartment with his mother (who was forced to go on welfare after Tim became sick), his aunt, and three other children. There just isn't enough food to go around.

Although A Lion in the House isn't scheduled to be shown nationwide on PBS-TV until early 2006, the experience of making the film led Ms. Reichert and Mr. Bognar to an important realization. "We didn't want to work on a film for 8 years and have it shown on TV only once," Ms. Reichert told the NIH audience. "That kept pushing us toward outreach."

That awareness led the filmmakers to secure funding from the Centers for Disease Control and Prevention and some nonprofit groups, including the Lance Armstrong Foundation and the Rockefeller Foundation, to pursue using the film to raise awareness among the public and medical professionals about issues such as cancer care disparities, survivorship, and end-of-life care.

The documentary is important, said CRCHD Director Dr. Harold P. Freeman during the screening, because it provides a snapshot of the entire cancer experience. "It offers the opportunity to show the broader picture - a child's ordeal with cancer, a poor family - a universal story," he said. "Because if it occurs for these children, it occurs for everybody."

While much of the education and outreach is still in the planning stages, shorter clips from the documentary - shot primarily at the Cincinnati Children's Hospital Medical Center - already are being pulled together into "educational modules" that speak to the filmmakers' goals to call national attention to health disparities, improve care, and strengthen support systems for childhood cancer patients and their families, especially those with socioeconomic challenges. Some modules have already been piloted with medical students and staff at Wright State University School of Medicine, where Ms. Reichert serves as a professor in both the Community Health and Theatre Arts departments.

Working with the Independent Television Service, which produces independent programming for PBS and was the initial source of funding for the film, Ms. Reichert and Mr. Bognar have begun to work more closely with the cancer community, bringing on partners such as the American Cancer Society and engaging in discussions with groups including the Oncology Nursing Society about developing continuing education materials based on the film. According to Dr. Emmanuel Taylor, of CRCHD's Health Policy Branch, NCI likely will be engaged in activities such as offering technical assistance on developing and evaluating the educational modules, including those for patient navigators, oncology doctors and nurses, new cancer patients and their families, and policy makers.

The filmmakers have high hopes for this project. "This is the hardest film we've ever made," Mr. Bognar said. "But I think it will be the most rewarding film we'll ever make."