Fasting Challenges among Patients with Cancer; Focus on Ramadan Fasting: A Systematic Review
Abstract
Background: We evaluated the effects of fasting on cancer treatment outcomes, gathering evidence separately from human clinical trials and in vitro (animal) studies.
Methods: A comprehensive search was conducted using the PubMed, Scopus, and Web of Science databases. Studies were included if they examined the effects of fasting on cancer treatment outcomes in vitro or in human subjects, regardless of study design, sample size, or country of origin.
Results: A total of 16 studies were included, consisting of 6 in vitro and animal studies and 10 human clinical trials. In vitro and animal studies consistently showed that fasting enhances the efficacy of chemotherapy and reduces its toxic side effects. Human clinical trials indicated that short-term fasting could decrease chemotherapy-induced side effects such as nausea, fatigue, and immunosuppression while improving overall response rates. However, the number of clinical trials is limited, and there is significant variability in study designs, fasting protocols, and endpoints.
Conclusion: Fasting may serve as a beneficial adjunct to cancer therapy, particularly in mitigating chemotherapy-induced side effects and enhancing treatment efficacy. Despite these promising results, further large-scale, well-designed clinical trials are necessary to confirm these findings and establish standardized fasting protocols. Future research should also investigate the long-term effects of fasting and its impact on different cancer types and treatment modalities. While some patients may fast without significant adverse effects, the primary concern should always be their safety and well-being.
1. Farzad M, Hamideh R, Bahareh S, et al (2018). Multicenter Survey of Ramadan Fasting among Cancer Patient and Healthcare Professionals in the I.R. Iran. Basic Clin Cancer Res, 10(1):3-11.
2. Attinà A, Leggeri C, Paroni R, et al (2021). Fasting: How to Guide. Nutrients, 13 (5):1570.
3. Zeeneldin AA, Taha FM (2012). Fasting among Muslim cancer patients during the holy month of Ramadan. Ann Saudi Med, 32 (3):243-9.
4. de Groot S, Pijl H, van der Hoeven JJM, et al (2019). Effects of short-term fasting on cancer treatment. J Exp Clin Cancer Res, 38 (1):209.
5. Siegel RL, Giaquinto AN, Jemal A (2024). Cancer statistics, 2024. CA Cancer J Clin, 74 (1):12-49.
6. Thun MJ, DeLancey JO, Center MM, et al (2010). The global burden of cancer: priorities for prevention. Carcinogenesis, 31 (1):100-10.
7. Anand U, Dey A, Chandel AKS, et al (2023). Cancer chemotherapy and beyond: Current status, drug candidates, associated risks and progress in targeted therapeutics. Genes Dis, 10 (4):1367-1401.
8. Di Biase S, Longo VD (2016). Fasting-induced differential stress sensitization in cancer treatment. Mol Cell Oncol, 3 (3):e1117701.
9. Safdie FM, Dorff T, Quinn D, et al (2009). Fasting and cancer treatment in humans: A case series report. Aging (Albany NY), 1 (12):988-1007.
10. Sadeghian M, Rahmani S, Khalesi S, et al (2021). A review of fasting effects on the response of cancer to chemotherapy. Clin Nutr, 40 (4):1669-1681.
11. Clifton KK, Ma CX, Fontana L, et al (2021). Intermittent fasting in the prevention and treatment of cancer. CA Cancer J Clin, 71 (6):527-546.
12. Karagöz A, Vural A, Çelik A, et al (2014). Comment on fasting among Muslim cancer patients during the holy month of Ramadan. Ann Saudi Med, 34 (4):361.
13. Lee C, Raffaghello L, Brandhorst S, et al (2012). Fasting cycles retard growth of tumors and sensitize a range of cancer cell types to chemotherapy. Sci Transl Med, 4 (124):124ra27.
14. Delconte RB, Owyong M, Santosa EK, et al (2024). Fasting reshapes tissue-specific niches to improve NK cell-mediated anti-tumor immunity. Immunity, 57 (8):1923-1938.e7.
15. Lv M, Zhu X, Wang H, et al (2014). Roles of caloric restriction, ketogenic diet and intermittent fasting during initiation, progression and metastasis of cancer in animal models: a systematic review and meta-analysis. PLoS One, 9 (12):e115147.
16. Simone BA, Palagani A, Strickland K, et al (2018). Caloric restriction counteracts chemotherapy-induced inflammation and increases response to therapy in a triple negative breast cancer model. Cell Cycle, 17 (13):1536-1544.
17. Vernieri C, Fucà G, Ligorio F, et al (2022). Fasting-Mimicking Diet Is Safe and Reshapes Metabolism and Antitumor Immunity in Patients with Cancer. Cancer Discov, 12 (1):90-107.
18. Di Biase S, Shim HS, Kim KH, et al (2017). Fasting regulates EGR1 and protects from glucose- and dexamethasone-dependent sensitization to chemotherapy. PLoS Biol, 15 (3):e2001951.
19. Tiwari S, Sapkota N, Han Z (2022). Effect of fasting on cancer: A narrative review of scientific evidence. Cancer Sci, 113 (10):3291-3302.
20. Arends J, Bachmann P, Baracos V, et al (2017). ESPEN guidelines on nutrition in cancer patients. Clin Nutr, 36 (1):11-48.
21. Kikomeko J, Schutte T, van Velzen MJM, et al (2023). Short-term fasting and fasting mimicking diets combined with chemotherapy: a narrative review. Ther Adv Med Oncol, 15:17588359231161418.
22. Trojani A, Bossi LE, Cairoli R (2024). Fasting and Diet: Overview in Chronic Lymphocytic Leukemia. Hemato, 5 (4):420-433.
23. Omar EM, Omran GA, Mustafa MF, et al (2022). Intermittent fasting during adjuvant chemotherapy may promote differential stress resistance in breast cancer patients. J Egypt Natl Canc Inst, 34 (1):38.
24. Alshammari K, Alhaidal HA, Alharbi R, et al (2023). The Impact of Fasting the Holy Month of Ramadan on Colorectal Cancer Patients and Two Tumor Biomarkers: A Tertiary-Care Hospital Experience. Cureus, 15 (1):e33920.
25. Vernieri C, Ligorio F, Zattarin E, et al (2020). Fasting-mimicking diet plus chemotherapy in breast cancer treatment. Nat Commun, 11 (1):4274.
26. Safdie F, Brandhorst S, Wei M, et al (2012). Fasting enhances the response of glioma to chemo-and radiotherapy. PLoS One, 7(9):e44603.
27. Koppold-Liebscher D, Kessler CS, Steckhan N, et al (2020). Short-term fasting accompanying chemotherapy as a supportive therapy in gynecological cancer: protocol for a multicenter randomized controlled clinical trial. Trials, 21 (1):854.
28. Bauersfeld SP, Kessler CS, Wischnewsky M, et al (2018). The effects of short-term fasting on quality of life and tolerance to chemotherapy in patients with breast and ovarian cancer: a randomized cross-over pilot study. BMC Cancer, 18 (1):476.
29. Zeeneldin AA, Gaber AA, Taha FM (2012). Does fasting during Ramadan trigger non-adherence to oral hormonal therapy in breast cancer patients? J Egypt Natl Canc Inst, 24 (3):133-7.
30. Bragazzi NL, Briki W, Khabbache H, et al (2016). Ramadan Fasting and Patients with Cancer: State-of-the-Art and Future Prospects. Front Oncol, 6:27.
31. Stringer EJ, Cloke RWG, Van der Meer L, et al (2024). The Clinical Impact of Time-restricted Eating on Cancer: A Systematic Review. Nutr Rev. 1;83(7):e1660-e1676.
32. Lachgar A, Ridai S, Mouafik S, et al (2022). [Ramadan fasting during treatment with external beam radiotherapy]. Bull Cancer, 109 (3):331-337.
33. Yassin MA, Ghasoub RS, Aldapt MB, et al (2019). Effects of Ramadan Fasting in Patients with Chronic Myeloid Leukemia in Chronic Phase. Blood, 134:5907.
34. Yassin MA, Ghasoub RS, Aldapt MB, et al (2021). Effects of Intermittent Fasting on Response to Tyrosine Kinase Inhibitors (TKIs) in Patients With Chronic Myeloid Leukemia: An Outcome of European LeukemiaNet Project. Cancer Control, 28:10732748211009256.
35. Hassan-Beck R, Hafidh K, Badi A, Dougman K, et al (2022). Ramadan Fasting in Health and Disease in 2021: A Narrative Review. Ibnosina J Med Biomed Sci, 14:50-67.
36. Al-Dubai HN, Yassin MA, Abdulla MA, et al (2020). Ramadan Fasting in a Patient with Chronic Myeloid Leukemia Receiving Nilotinib as Upfront. Case Rep Oncol, 13 (2):664-667.
37. Benkhadra M, Fituri N, Aboukhalaf S, et al (2024). The Safety of Novel Therapies in Chronic Lymphocytic Leukemia in the Era of Intermittent Fasting: A Pharmacology-Based Review. Cancers (Basel), 16 (11):2079.
38. Chang SH, Luo S, Thomas TS, et al (2016). Obesity and the Transformation of Monoclonal Gammopathy of Undetermined Significance to Multiple Myeloma: A Population-Based Cohort Study. J Natl Cancer Inst, 109(5):djw264.
39. Kleinstern G, Larson DR, Allmer C, et al (2022). Body mass index associated with monoclonal gammopathy of undetermined significance (MGUS) progression in Olmsted County, Minnesota. Blood Cancer J, 12 (4):67.
40. Thordardottir M, Lindqvist EK, Lund SH, et al (2017). Obesity and risk of monoclonal gammopathy of undetermined significance and progression to multiple myeloma: a population-based study. Blood Adv, 1 (24):2186-2192.
41. Patterson RE, Laughlin GA, LaCroix AZ, et al (2015). Intermittent Fasting and Human Metabolic Health. J Acad Nutr Diet, 115 (8):1203-12.
42. Liu D, Huang Y, Huang C, et al (2022). Calorie Restriction with or without Time-Restricted Eating in Weight Loss. N Engl J Med, 386 (16):1495-1504.
43. Dorff TB, Groshen S, Garcia A, et al (2016). Safety and feasibility of fasting in combination with platinum-based chemotherapy. BMC Cancer, 16 (1):360.
44. Raucci F, Vernieri C, Di Tano M, et al (2024). Cyclic Fasting-Mimicking Diet Plus Bortezomib and Rituximab Is an Effective Treatment for Chronic Lymphocytic Leukemia. Cancer Res, 84 (7):1133-1148.
45. Faris MA, Kacimi S, Al-Kurd RA, et al (2012). Intermittent fasting during Ramadan attenuates proinflammatory cytokines and immune cells in healthy subjects. Nutr Res, 32 (12):947-55.
46. Tas F, Karabulut S, Ciftci R, et al (2014). The behavior of Turkish cancer patients in fasting during the holy month of Ramadan. Jpn J Clin Oncol, 44 (8):705-10.
47. Altuntas YE, Gezen FC, Sahoniz T, et al (2013). Ramadan fasting in patients with a stoma: a prospective study of quality of life and nutritional status. Ostomy Wound Manage, 59 (5):26-32.
2. Attinà A, Leggeri C, Paroni R, et al (2021). Fasting: How to Guide. Nutrients, 13 (5):1570.
3. Zeeneldin AA, Taha FM (2012). Fasting among Muslim cancer patients during the holy month of Ramadan. Ann Saudi Med, 32 (3):243-9.
4. de Groot S, Pijl H, van der Hoeven JJM, et al (2019). Effects of short-term fasting on cancer treatment. J Exp Clin Cancer Res, 38 (1):209.
5. Siegel RL, Giaquinto AN, Jemal A (2024). Cancer statistics, 2024. CA Cancer J Clin, 74 (1):12-49.
6. Thun MJ, DeLancey JO, Center MM, et al (2010). The global burden of cancer: priorities for prevention. Carcinogenesis, 31 (1):100-10.
7. Anand U, Dey A, Chandel AKS, et al (2023). Cancer chemotherapy and beyond: Current status, drug candidates, associated risks and progress in targeted therapeutics. Genes Dis, 10 (4):1367-1401.
8. Di Biase S, Longo VD (2016). Fasting-induced differential stress sensitization in cancer treatment. Mol Cell Oncol, 3 (3):e1117701.
9. Safdie FM, Dorff T, Quinn D, et al (2009). Fasting and cancer treatment in humans: A case series report. Aging (Albany NY), 1 (12):988-1007.
10. Sadeghian M, Rahmani S, Khalesi S, et al (2021). A review of fasting effects on the response of cancer to chemotherapy. Clin Nutr, 40 (4):1669-1681.
11. Clifton KK, Ma CX, Fontana L, et al (2021). Intermittent fasting in the prevention and treatment of cancer. CA Cancer J Clin, 71 (6):527-546.
12. Karagöz A, Vural A, Çelik A, et al (2014). Comment on fasting among Muslim cancer patients during the holy month of Ramadan. Ann Saudi Med, 34 (4):361.
13. Lee C, Raffaghello L, Brandhorst S, et al (2012). Fasting cycles retard growth of tumors and sensitize a range of cancer cell types to chemotherapy. Sci Transl Med, 4 (124):124ra27.
14. Delconte RB, Owyong M, Santosa EK, et al (2024). Fasting reshapes tissue-specific niches to improve NK cell-mediated anti-tumor immunity. Immunity, 57 (8):1923-1938.e7.
15. Lv M, Zhu X, Wang H, et al (2014). Roles of caloric restriction, ketogenic diet and intermittent fasting during initiation, progression and metastasis of cancer in animal models: a systematic review and meta-analysis. PLoS One, 9 (12):e115147.
16. Simone BA, Palagani A, Strickland K, et al (2018). Caloric restriction counteracts chemotherapy-induced inflammation and increases response to therapy in a triple negative breast cancer model. Cell Cycle, 17 (13):1536-1544.
17. Vernieri C, Fucà G, Ligorio F, et al (2022). Fasting-Mimicking Diet Is Safe and Reshapes Metabolism and Antitumor Immunity in Patients with Cancer. Cancer Discov, 12 (1):90-107.
18. Di Biase S, Shim HS, Kim KH, et al (2017). Fasting regulates EGR1 and protects from glucose- and dexamethasone-dependent sensitization to chemotherapy. PLoS Biol, 15 (3):e2001951.
19. Tiwari S, Sapkota N, Han Z (2022). Effect of fasting on cancer: A narrative review of scientific evidence. Cancer Sci, 113 (10):3291-3302.
20. Arends J, Bachmann P, Baracos V, et al (2017). ESPEN guidelines on nutrition in cancer patients. Clin Nutr, 36 (1):11-48.
21. Kikomeko J, Schutte T, van Velzen MJM, et al (2023). Short-term fasting and fasting mimicking diets combined with chemotherapy: a narrative review. Ther Adv Med Oncol, 15:17588359231161418.
22. Trojani A, Bossi LE, Cairoli R (2024). Fasting and Diet: Overview in Chronic Lymphocytic Leukemia. Hemato, 5 (4):420-433.
23. Omar EM, Omran GA, Mustafa MF, et al (2022). Intermittent fasting during adjuvant chemotherapy may promote differential stress resistance in breast cancer patients. J Egypt Natl Canc Inst, 34 (1):38.
24. Alshammari K, Alhaidal HA, Alharbi R, et al (2023). The Impact of Fasting the Holy Month of Ramadan on Colorectal Cancer Patients and Two Tumor Biomarkers: A Tertiary-Care Hospital Experience. Cureus, 15 (1):e33920.
25. Vernieri C, Ligorio F, Zattarin E, et al (2020). Fasting-mimicking diet plus chemotherapy in breast cancer treatment. Nat Commun, 11 (1):4274.
26. Safdie F, Brandhorst S, Wei M, et al (2012). Fasting enhances the response of glioma to chemo-and radiotherapy. PLoS One, 7(9):e44603.
27. Koppold-Liebscher D, Kessler CS, Steckhan N, et al (2020). Short-term fasting accompanying chemotherapy as a supportive therapy in gynecological cancer: protocol for a multicenter randomized controlled clinical trial. Trials, 21 (1):854.
28. Bauersfeld SP, Kessler CS, Wischnewsky M, et al (2018). The effects of short-term fasting on quality of life and tolerance to chemotherapy in patients with breast and ovarian cancer: a randomized cross-over pilot study. BMC Cancer, 18 (1):476.
29. Zeeneldin AA, Gaber AA, Taha FM (2012). Does fasting during Ramadan trigger non-adherence to oral hormonal therapy in breast cancer patients? J Egypt Natl Canc Inst, 24 (3):133-7.
30. Bragazzi NL, Briki W, Khabbache H, et al (2016). Ramadan Fasting and Patients with Cancer: State-of-the-Art and Future Prospects. Front Oncol, 6:27.
31. Stringer EJ, Cloke RWG, Van der Meer L, et al (2024). The Clinical Impact of Time-restricted Eating on Cancer: A Systematic Review. Nutr Rev. 1;83(7):e1660-e1676.
32. Lachgar A, Ridai S, Mouafik S, et al (2022). [Ramadan fasting during treatment with external beam radiotherapy]. Bull Cancer, 109 (3):331-337.
33. Yassin MA, Ghasoub RS, Aldapt MB, et al (2019). Effects of Ramadan Fasting in Patients with Chronic Myeloid Leukemia in Chronic Phase. Blood, 134:5907.
34. Yassin MA, Ghasoub RS, Aldapt MB, et al (2021). Effects of Intermittent Fasting on Response to Tyrosine Kinase Inhibitors (TKIs) in Patients With Chronic Myeloid Leukemia: An Outcome of European LeukemiaNet Project. Cancer Control, 28:10732748211009256.
35. Hassan-Beck R, Hafidh K, Badi A, Dougman K, et al (2022). Ramadan Fasting in Health and Disease in 2021: A Narrative Review. Ibnosina J Med Biomed Sci, 14:50-67.
36. Al-Dubai HN, Yassin MA, Abdulla MA, et al (2020). Ramadan Fasting in a Patient with Chronic Myeloid Leukemia Receiving Nilotinib as Upfront. Case Rep Oncol, 13 (2):664-667.
37. Benkhadra M, Fituri N, Aboukhalaf S, et al (2024). The Safety of Novel Therapies in Chronic Lymphocytic Leukemia in the Era of Intermittent Fasting: A Pharmacology-Based Review. Cancers (Basel), 16 (11):2079.
38. Chang SH, Luo S, Thomas TS, et al (2016). Obesity and the Transformation of Monoclonal Gammopathy of Undetermined Significance to Multiple Myeloma: A Population-Based Cohort Study. J Natl Cancer Inst, 109(5):djw264.
39. Kleinstern G, Larson DR, Allmer C, et al (2022). Body mass index associated with monoclonal gammopathy of undetermined significance (MGUS) progression in Olmsted County, Minnesota. Blood Cancer J, 12 (4):67.
40. Thordardottir M, Lindqvist EK, Lund SH, et al (2017). Obesity and risk of monoclonal gammopathy of undetermined significance and progression to multiple myeloma: a population-based study. Blood Adv, 1 (24):2186-2192.
41. Patterson RE, Laughlin GA, LaCroix AZ, et al (2015). Intermittent Fasting and Human Metabolic Health. J Acad Nutr Diet, 115 (8):1203-12.
42. Liu D, Huang Y, Huang C, et al (2022). Calorie Restriction with or without Time-Restricted Eating in Weight Loss. N Engl J Med, 386 (16):1495-1504.
43. Dorff TB, Groshen S, Garcia A, et al (2016). Safety and feasibility of fasting in combination with platinum-based chemotherapy. BMC Cancer, 16 (1):360.
44. Raucci F, Vernieri C, Di Tano M, et al (2024). Cyclic Fasting-Mimicking Diet Plus Bortezomib and Rituximab Is an Effective Treatment for Chronic Lymphocytic Leukemia. Cancer Res, 84 (7):1133-1148.
45. Faris MA, Kacimi S, Al-Kurd RA, et al (2012). Intermittent fasting during Ramadan attenuates proinflammatory cytokines and immune cells in healthy subjects. Nutr Res, 32 (12):947-55.
46. Tas F, Karabulut S, Ciftci R, et al (2014). The behavior of Turkish cancer patients in fasting during the holy month of Ramadan. Jpn J Clin Oncol, 44 (8):705-10.
47. Altuntas YE, Gezen FC, Sahoniz T, et al (2013). Ramadan fasting in patients with a stoma: a prospective study of quality of life and nutritional status. Ostomy Wound Manage, 59 (5):26-32.
| Files | ||
| Issue | Vol 54 No 8 (2025) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i8.19579 | |
| Keywords | ||
| Fasting Cancer therapy Chemotherapy Hormonal therapy | ||
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How to Cite
1.
Ghalamkari M, Sahebi L, Toogeh S, Toogeh G. Fasting Challenges among Patients with Cancer; Focus on Ramadan Fasting: A Systematic Review. Iran J Public Health. 2025;54(8):1701-1711.
