To fast or not to fast: Should cancer patients fast during Ramadan?
Resource person: Dr Matin Mellor Abdullah, Consultant Clinical Oncologist, OncoCare Malaysia
Dr Matin Mellor Abdullah
Fasting in the holy month of Ramadan is an important pillar of Islam that encourages prayer, self-discipline, and spiritual reflection. While all Muslims who are mukallaf (have reached puberty and are of sound mind) are required to fast from sunrise to sunset, exemptions are made for several categories, including those who are ill, receiving treatment, or recovering from serious illness, injury, or surgery.
“While those who are ill or receiving treatment for a serious illness are exempt, many faithful feel the spiritual need to do so.” – Dr Mellor”
In spite of this, the desire to participate in this spiritual journey is strong and many cancer patients still wish to proceed with fasting. The question is, should they?
Dr Mellor advises a pragmatic approach that treads a cautious line between practicality, safety and spirituality.
“Many patients I see are open with me about their intention to fast. While I can advise them on medical matters, there are no official guidelines available hence I also advise them to speak to their ustaz so they can have clarity and peace of mind about their spiritual obligations,” he said.
When it comes to their health, these are things every cancer patient should consider if they wish to fast this Ramadan.
1. Every cancer patient is on a different point in their treatment journey.
“For patients who have already undergone treatment or are in maintenance, there should be no impediment to fasting. However, those who are currently undergoing investigations may find it challenging due to the required tests, and those in the midst of receiving therapy may need to make adjustments to their medication schedule,” explained Dr Mellor.
Furthermore, Dr Mellor said those who are receiving curative treatment may wish to forgo fasting and adhere to their planned treatment schedule to maximize their chance of cure, while patients receiving palliative treatment may temporarily defer treatment and resume after Ramadan.
However, each patient must be evaluated on a case-by-case basis, he stresses, with due consideration for the patient’s health and wellbeing.
2. There are different types of treatment, and every cancer patient tolerates treatment differently.
Patients with cancer may be receiving radiotherapy, chemotherapy, or targeted therapy, and each of them are associated with a different range of side effects, with some patients being more affected than others.
To cite an example, Dr Mellor said, “Chemotherapy remains the mainstay of cancer treatment, and it is common for patients to feel unwell for a few days or even up to a week. Side effects can include loss of appetite, feeling weak, developing mouth ulcers, and gastrointestinal discomfort like diarrhoea or gastritis. Sometimes, the side effects are so severe that medications are necessary to control the nausea or diarrhoea. Because of these factors, the individual ability to tolerate both treatment and fasting differs from patient to patient.”
3. Treatment schedules can be adjusted, with medical supervision.
“If you wish to fast while on treatment, be sure to discuss this with your doctor first so we can advise you on adjusting medication schedules and address any concerns,” said Dr Mellor.
Treatment options vary according to the type of cancer, its location and stage, he explained.
– Oral medication. These may include oral chemotherapy and medications to manage nausea and pain, which are usually taken twice daily and can be timed for sahur and iftar.
– Hormone therapy. These are usually taken once daily and patients who are already familiar with the side effects may adjust the timing so that nausea medications may be taken if needed. Among patients who have received several cycles of treatment, familiarity with its side effects may make it possible to plan their fasting accordingly.
– Radiotherapy and nuclear medicine procedures. These are administered at the hospital and may be scheduled accordingly, based on availability and your doctor’s advice.
4. Prioritise your wellbeing.
“Many patients try to fast with good intentions but are unable to complete it, which can be disappointing. I would advise patients to refrain from fasting if they are recovering from surgery or who are nutrient-deficient as the body may not be able to tolerate fasting under such circumstances,” said Dr Mellor.
For those fasting, he advises being careful to get sufficient hydration and to eat a balanced diet that is rich in fruits, vegetables and protein so they get the nutrition they need.
At the end of the day, said Dr Mellor, “It is a deeply personal decision, and I remind all my patients that it is also important to recognise their body’s limits – there is no medication for tiredness and sometimes, your body just needs rest and recovery so reflect deeply on your decision, speak to your doctor, listen to your body and act accordingly.”
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