Attitudes to and effects of fasting on Yom Kippur in cancer patients receiving chemotherapy: To fast or not to fast on Yom Kippur

Abstract

Background: Almost four-fifth of the Jewish people in Israel fast on Yom Kippur. The Jewish law exempts patients from fasting if the fast endangers the patient's health. There no previous study has focused on Yom Kippur fasting in the cancer patients treated with chemotherapy. The aim of the present study, therefore, was to assess attitudes towards fasting on Yom Kippur in these patients, and tolerance of the 25-hour fast in those who observed it.

Methods: The sample comprised 31cancer patients receiving chemotherapy in the Day Care Unit of Shaare Zedek Medical Center, all of whom were individually interviewed regarding fasting on Yom Kippur. Patients were asked whether they were fasting on Yom Kippur, whether sought an oncologist’s or Rabbis advice was sought before undertaking fasting, and what that advice was. The following data were collected for all participants: age, gender, the stage of the cancer (metastatic vs nonmetastatic), religious status and social status. The data were transcribed into an electronic database within Microsoft Excel®.

On the day of interview, all participants were examined by oncology day care nursing staff. The examination included vital signs, symptom and well being questionnaire and routine blood test examination.

Results: Chemotherapy-treated patients tended to ask their doctor or Rabbi whether they should fast on Yom Kippur. In the majority of cases they were advised not to fast or a form of partial fasting was recommended.  Regardless of advice by doctors and Rabbis to the contrary, 6 patients chose to observe the fast strictly, despite chemotherapy; 12 to drink Shiurim (Minimum Quantities) and only 11 decided not to fast.

In general, the 25-hour fast was well tolerated. All 6 patients who observed it strictly completed it successfully. Five of these reported normal activity during the fast and one felt weaker than normal. Ten of the 12 drinking Shiurim completed the 25 hours of the fast; 9 of these reported normal activity during the fast and 3 felt weaker than normal.

Conclusions: Most patients who traditionally fasted in Yom Kippur asked their doctor and/or Rabbi's advice regarding fasting. Despite recommendations to the contrary, most patients continued to fast, and in general, tolerated it well.