I work in West Philadelphia, where we have a robust and devoted Muslim community. Many of my patients observe Ramadan, which will take place this year (2023) from sundown on March 22 until April 21. Ramadan is a time of prayer and reflection during which observers fast from dawn to sundown each day, for the entire month. All food and drinks (including water) are prohibited during this period, as are other “sinful” behaviors such as using tobacco and engaging in sexual relations.
For my patients with cancer who are on chemotherapy, there can be considerations. I had a discussion with one of my patients about this recently. In the past, some of my patients observing Ramadan did allow themselves to have small amounts of water and food, as they were considered “acutely or chronically ill.” Within the religion of Islam, there is a medical exception for people who are ill, breastfeeding, and in some other situations.
However, this particular patient of mine—who has metastatic NSCLC and is on chemotherapy plus immunotherapy—will not consider breaking the fast for any reason. For him, his extremely strong faith is his highest value. He communicated to me that he would not even consider drinking water during the daylight fasting period, as this would be incredibly disrespectful and sinful.
So we worked together to develop a plan: He will eat and drink as he usually would after sunset and before dawn. We’ll monitor his lab work—particularly his renal function—and other medical parameters to be able to support him in the best way possible during this time. It may be more reasonable for him to have to miss or hold a chemotherapy treatment rather than break his fast. For him, he tells me that he believes in and answers to “The One and Only,” and that that relationship supersedes his cancer diagnosis. I respect my patient’s beliefs and wishes, and will work with him to give him the best cancer care possible while respecting his faith and values.