Original Articles

Multicenter Survey of Ramadan Fasting among Cancer Patient and Healthcare Professionals in the I.R. Iran


Background: Muslim cancer patients and healthcare professionals face several challenges about the necessity of fasting and its possible side effects during the holy month of Ramadan. We aimed to study the prevalence of fasting among cancer patients during Ramadan and opinions of health care professionals about fasting among cancer patients in Iran. Methods: We conducted a cross-sectional survey during the Ramadan (July-August) in 2013. Participants were 620 cancer patients and, 187 healthcare professionals in several cancer clinics from different provinces of Iran. We used self-administered questionnaires and collected data from patients, and healthcare professionals to collect data. We performed descriptive analysis by using Stata statistical software. Results: Out of 620 patients who participated in this study, 428 (69%) were women. 76 (13%) of patients had fasted for at least a day during Ramadan and, from which 41 (7%) had fasted whole months because of their religious belief. Among patients who had refrained from fasting, the reasons were lack of sufficient physical strength (403, 65%), excessive thirst (141, 23%). 275 (44%) of participants had consulted with their physician about fasting. We found that more than 50% of physicians advised against fasting for patients following surgery, pre-operation, recent hospitalization, and consumption of oral or intravenous chemotherapy. Most of the healthcare professionals (68%) believed that cancer survivors could not fast even if they have no signs or symptoms or side-effects after the treatment.Conclusion: Although most of the cancer patients refrain from fasting, some cancer patients practice fasting and face challenges during the holy month of Ramadan in Iran. Most patients consult about fasting in Ramadan with their doctor who has variable opinions about this issue. Development of guidelines for healthcare professional and cancer patients regarding Ramadan fasting is needed.  

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet‐Tieulent J, Jemal A. Global cancer statistics, 2012. CA: a cancer journal for clinicians. 2015;65(2):87-108.

Mohebbi E, Nahvijou A, Hadji M, Rashidian H, Seyyedsalehi MS, Nemati S, et al. Iran Cancer Statistics in 2012 and projection of cancer incidence by 2035. Basic & Clinical Cancer Research. 2017;9(3).

Grim BJ, Hsu B. Estimating the Global Muslim Population: Size and Distribution of the World's Muslim Population. Interdisciplinary Journal of Research on Religion. 2011;7.

Hursting SD, Kari FW. The anti-carcinogenic effects of dietary restriction: mechanisms and future directions. Mutation Research/Genetic Toxicology and Environmental Mutagenesis. 1999;443(1):235-49.

Hursting SD, Lavigne JA, Berrigan D, Perkins SN, Barrett JC. Calorie restriction, aging, and cancer prevention: Mechanisms of action and applicability to humans*. Annual review of medicine. 2003;54(1):131-52.

Chtourou H, Hammouda O, Chaouachi A, Chamari K, Souissi N. The effect of time-of-day and Ramadan fasting on anaerobic performances. International journal of sports medicine. 2012;33(2):142.

Safdie F, Brandhorst S, Wei M, Wang W, Lee C, Hwang S, et al. Fasting enhances the response of glioma to chemo-and radiotherapy. PloS one. 2012;7(9):e44603.

Lee C, Longo V. Fasting vs dietary restriction in cellular protection and cancer treatment: from model organisms to patients. Oncogene. 2011;30(30):3305-16.

Safdie FM, Dorff T, Quinn D, Fontana L, Wei M, Lee C, et al. Fasting and cancer treatment in humans: A case series report. Aging (Albany NY). 2009;1(12):988-1007.

Penna F, Baccino FM, Costelli P. Pathogenesis of cancer cachexia. Pathogenesis. 2013:20-33.

Wheelwright S, Darlington A-S, Hopkinson JB, Fitzsimmons D, White A, Johnson CD. A systematic review of health-related quality of life instruments in patients with cancer cachexia. Supportive Care in Cancer. 2013;21(9):2625-36.

Iqbal F. What should doctors do about fasting during Ramadan? 2012.

Bragazzi NL, Briki W, Khabbache H, Rammouz I, Chamari K, Demaj T, et al. Ramadan Fasting and Patients with Cancer: State-of-the-Art and Future Prospects. Frontiers in Oncology. 2016;6(27).

Zeeneldin AA, Tahab FM. Fasting among Muslim cancer patients during the holy month of Ramadan. Annals of Saudi medicine. 2012;32(3).

Tas F, Karabulut S, Ciftci R, Yildiz I, Keskin S, Kilic L, et al. The behavior of Turkish cancer patients in fasting during the holy month of Ramadan. Japanese journal of clinical oncology. 2014;44(8):705-10.

Iraki L, Bogdan A, Hakkou F, Amrani N, Abkari A, Touitou Y. Ramadan Diet Restrictions Modify the Circadian Time Structure in Humans. A Study on Plasma Gastrin, Insulin, Glucose, and Calcium and on Gastric pH 1. The Journal of Clinical Endocrinology & Metabolism. 1997;82(4):1261-73.

Shehab A, Abdulle A, El Issa A, Al Suwaidi J, Nagelkerke N. Favorable changes in lipid profile: the effects of fasting after Ramadan. PloS one. 2012;7(10):e47615.

Patel T, Magdum A, Ghura V. Does fasting during Ramadan affect the use of topical dermatological treatment by Muslim patients in the UK? Clinical and experimental dermatology. 2012;37(7):718-21.

Yakasai AM, Muhammad H, Babashani M, Jumare J, Abdulmumini M, Habib AG. Once-daily antiretroviral therapy among treatment-experienced Muslim patients fasting for the month of Ramadan. Tropical doctor. 2011;41(4):233-5.

Holt-Lunstad J, Steffen PR, Sandberg J, Jensen B. Understanding the connection between spiritual well-being and physical health: an examination of ambulatory blood pressure, inflammation, blood lipids and fasting glucose. Journal of behavioral medicine. 2011;34(6):477-88.

Ong KJ, Back MF, Lu JJ, Shakespeare TS, Wynne CJ. Cultural attitudes to cancer management in traditional South‐East Asian patients. Journal of Medical Imaging and Radiation Oncology. 2002;46(4):370-4.

Sarraf-Zadegan N, Atashi M, Naderi GA, Baghai AM, Asgary S, Fatehifar MR, et al. The effect of fasting in Ramadan on the values and interrelations between biochemical, coagulation and hematological factors. Annals of Saudi medicine. 2000;20(5/6):377-81.

Khan Khattak MMA, Abu Bakar I, Yeim L. Does religious fasting increase fat free mass (FFM) and reduce abdominal obesity? Nutrition & Food Science. 2012;42(2):87-96.

Panju ZI. Patients who fast in Ramadan need better advice. 2012.

Renard J. The Handy Islam Answer Book: Visible Ink Press, https://books.google.com/books?hl=en&lr=&id=NoqDBwAAQBAJ&oi=fnd&pg=PP1&ots=wGOfvFUA01&sig=hFaaPJewhfvhZF-MrGewFNjsg6Q#v=onepage&q&f=false; 2015.

IssueVol 10 No 1 (2018) QRcode
SectionOriginal Articles
Cancer patients Behavior Fasting Ramadan Clinician Opinion Iran

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Maleki F, Rashidian H, Sasanfar B, Majidi A, Toorang F, Nahvijou A, Homaei Shandiz F, Janbabaei G, Borhani S, Roshandel G, Sedaghat Z, Marzban M, Ghanbari Motalgh A, Mohammadzadeh D, Kazemian A, Mohagheghi MA, Zendehdel K. Multicenter Survey of Ramadan Fasting among Cancer Patient and Healthcare Professionals in the I.R. Iran. Basic Clin Cancer Res. 2018;10(1):3-11.