Religious Practices During Cancer Treatment

NCI's patient summary separates two words people often blend. "Religion may be defined as a specific set of beliefs and practices, usually within an organized group." Spirituality is wider. NCI calls it "an individual's sense of peace, purpose, and connection to others, and beliefs about the meaning of life." A person may hold one, both, or neither.

This belongs in a cancer clinic for plain reasons. NCI reports that spiritual and religious well-being may lower anxiety, depression, anger, and discomfort. It may reduce isolation and suicide risk. It may raise hope and inner peace. It may help a person adjust to cancer and its treatment.

The other side is real too. NCI names spiritual distress as a known problem. In it, a person may feel "that they are being punished by God or may have a loss of faith."

You are also free to skip the subject. NCI says patients who do not want to discuss spirituality "should also be able to count on the health care team to respect their wishes."

A team cannot plan around a practice it never hears about. Sort yours into three groups first.

Essential practices cannot move. Prayer at fixed times. A fast on a set date. A ritual before surgery. Flexible practices still matter, but the timing can shift. Private practices belong on the chart without a conversation.

NCI's summary for clinicians describes a spiritual history tool called SPIRIT. Two of its six domains are exactly what you need to raise. One is "ritualized practices and restrictions." The other is "implications for medical care." A shorter tool, FICA, covers faith, importance, community, and address.

Do not wait to be asked. The American Cancer Society suggests plain openers, such as "Do you have any advice for finding spiritual support?"

A hospital chaplain is a trained spiritual care professional. NCI's clinician summary says chaplains "can play a key role because they are trained to work with a wide range of issues as they arise for patients and to be sensitive to patients' diverse beliefs and concerns."

There is a gap you should plan around. NCI notes that chaplains are "rarely available in outpatient settings where most cancer care is now delivered." Most chemotherapy is given in outpatient infusion units. So ask who covers spiritual care at the clinic you actually attend, and how to reach that person on a treatment day. A chaplain can also help you contact your own clergy.

Fasting is where belief and biology meet most often. Ramadan, Yom Kippur, and Lent fall on dates that will not move for a chemotherapy calendar.

Start with the religious ruling, because it may surprise you. Macmillan Cancer Support quotes a scholar on Ramadan: "If fasting causes harm or difficulty, it is not required." The same piece adds, "There is no act of worship that you are obligated to do if it causes you harm or pain."

Two practical points come from that source. Oral medicine breaks a fast, because "while fasting you don't ingest anything. Water, food or medicine." Injections are judged by purpose. Nutrition given into a vein would break the fast. A vaccine or an antibiotic would not.

If you cannot fast, Macmillan lists accepted alternatives. You can make up missed days later if your health improves. You can feed one hungry person for each day missed. You can keep prayer, reading, and charity.

Bring three people into this choice: your oncology nurse or doctor, a dietitian, and your imam, rabbi, priest, or elder. A ruling from one without the other two is half an answer.

Ask early which items may stay on, and who removes them if they cannot.

Scanning rooms have hard limits. The FDA warns that an MRI magnet will "attract magnetic objects" and that these "may cause damage to the scanner or injury to the patient." Metal pins in a head covering, a steel bangle, or a medal on a chain all count. The FDA also warns that MRI energy "may cause heating of the implanted medical device and the surrounding tissue, which could lead to burns."

That is a physics limit, not a judgment about your faith. It is still a limit. Ask whether a metal-free replacement is allowed, whether a family member or a same-gender staff member can handle the item, and where it will be kept.

NCI's clinician summary reports a finding worth knowing. Among people with advanced cancer, "greater religious involvement may also be linked to an increased likelihood of desire for extreme measures at the end of life." Religiousness was linked to a preference for "wanting all measures taken to extend life."

That is not a criticism. It is a reason to write your wishes down while you are well. If your faith shapes what you want at the end, put it in an advance directive. An advance directive is a legal form that records your treatment wishes and names who speaks for you. Tell that person about any ritual that must happen near the time of death, and how quickly it must happen.

Fasting can hide the early signs of a treatment problem. Weakness and dizziness get blamed on the fast instead.

A fever during cancer treatment is not a wait-and-see problem. NCI says infections during cancer treatment can be life threatening and require urgent medical attention, so call the team straight away, at any hour, if:

• Your temperature reaches "100.4 °F (38 °C) or higher." CDC names this threshold. CDC also warns against taking a fever reducer first, because it may mask or hide signs of a more serious problem.
• You have chills, a new cough, a sore throat, a stiff neck, mouth sores, or redness at a catheter site. If you cannot reach anyone, go to an emergency department and say you are on cancer treatment.

Call the same day if you cannot keep fluids down for a full day, or if you miss a dose of a cancer medicine because of a fast and are unsure whether to take it.

Diarrhea also needs a call rather than a wait. NCI says seven or more bowel movements above your normal daily number can be life-threatening and may require treatment in a hospital.

• Spirituality in Cancer Care (PDQ) — Patient Version — National Cancer Institute
• Spirituality in Cancer Care (PDQ) — Health Professional Version — National Cancer Institute
• Spiritual Support and Cancer — American Cancer Society
• Navigating Fasting During Ramadan for Cancer Patients — Macmillan Cancer Support
• Benefits and Risks of MRI — U.S. Food and Drug Administration
• Infection and Neutropenia during Cancer Treatment — National Cancer Institute
• Diarrhea and Cancer Treatment — National Cancer Institute