The Positive Effects of Religiosity and Holy Quran Recitation on Stress and Anxiety in Cancer Patients; A systematic Review of Clinical Trials

Today, cancer is considered one of the principal health concerns with a high rate of death worldwide [1]. Chemotherapy, as one of the primary strategies for cancer treatment, is associated with some side effects that may cause anxiety [2]. Anxiety is characterized as a pervasive, unpleasant, and vague feeling of worry that is accompanied by symptoms such as heart palpitations, restlessness, headaches, and upset stomach [3,4]. In general, the methods used to reduce anxiety in people are divided into two categories: pharmacological and non-pharmacological approaches [4].

The use of pharmacological methods has always posed problems and complications in reducing anxiety in patients. Therefore, there is a growing need to utilize non-drug and complementary methods as safer, more cost-effective, and healthier approaches [5]. In recent years, several alternative therapeutic approaches, such as aromatherapy and music therapy, have been applied to control anxiety in patients [6]. Among non-pharmacological strategies, the use of pleasant sound stimuli, known as music therapy, is an alternative treatment that ameliorates the consequences of stress, improves the immune system, induces relaxation, and enhances the psycho-social, physiological, and emotional integration of a person. It aids in the treatment of illness and disability [7]. Therefore, it is considered a strong, inexpensive, non-invasive, and easy treatment method to control patients' anxiety [7]. One of the types of music is the music resulting from the recitation of the Holy Quran, which is one of the most magnificent aspects of the miracles of the Quran [8]. Reviews have reported the potent effects of listening to the Holy Quran recitation in reducing anxiety in various groups of patients, including those experiencing childbirth depression, Alzheimer's, obsessive disorders, cardiovascular issues, stroke, and surgical candidates [9]. The current study aims to review the effects of religiosity and recitation of the Holy Quran on stress and anxiety in cancer patients.

Search strategy

This systematic review was conducted following the PRISMA protocols and registered in the CAMARADES-NC3Rs Preclinical Systematic Review and Meta-Analysis Facility (SyRF) database [10]. The search for articles published without time limitations was conducted in databases using the strategy outlined in PubMed, Google Scholar, ScienceDirect, Web of Science, and Scopus. The keywords used were "Holy Quran," "Recitation," "Religiosity," "Stress," "Anxiety," "Cancer," "Chemotherapy," and "Clinical trial" (Figure 1).

Quality assessment and article selection

First, the papers were imported into EndNote X9 software, and duplicate papers were excluded. After reviewing the abstracts of the papers, the relevant papers that met the inclusion criteria were selected for further evaluation. Also, to enhance the search sensitivity, the references of the reviewed articles are checked for related articles (cross-referencing) [11].

 Figure 1: Flowchart of the review pattern according to the PRISMA practice.

Exclusion criteria

Papers with insufficient evidence, abstracts presented at conferences where the full text was unavailable, approaches that do not match outcomes, and misinterpretation of outcomes are excluded from the study.

Inclusion criteria and data extraction

All randomized clinical trials were included, and the extracted information included authors' names, year, country, type of cancer, sample size, results, and references. Three independent authors extracted information and any discrepancies were consulted with the corresponding author.

From 7625 articles, 16 articles containing 2409 cancer patients up to 2023 met the inclusion criteria for analysis in this review (Table 1). The majority of articles were from Iran (6, 37.5%), followed by Indonesia (4, 25.0%) (Fig. 2). The majority of the patients had breast cancer (6, 37.5%), followed by colon cancer (5, 31.25%), and cervical cancer (4, 25.0%). 

Table 1: List of papers regarding the effect of religiosity and Holy Quran recitation on stress and anxiety in cancer patients.

Figure 2: Geographical distribution of studies included in this review.

Nowadays, clinicians are attempting to treat and manage psychological illnesses such as stress and anxiety by incorporating religiosity and recitation of the Holy Quran. Music therapy, utilizing the rhythm and melody of words to divert the senses and reduce focus on disturbing stimuli, is a non-pharmacological and complementary medicine approach that can be applied in various treatment areas. It has been shown to help alleviate pain and anxiety in patients and individuals [28]. This therapeutic method exerts its effects by coordinating various physiological rhythms of the body and adjusting physiological responses in different ways. Religion and religious practices assist patients in adapting to their illness conditions, enhancing their social interactions, and preventing harmful behaviors like suicide [29]. One of the types of music is the music resulting from the recitation of the Qur'an. This mystical and delightful music, with special properties, its own melody, and rhythm, is one of the greatest aspects of the miracle of the Holy Qur'an [30]. In the Qur'an, a human being is considered from two dimensions: natural and supernatural. However, these two dimensions are not presented as identical and equal. The supernatural dimension is emphasized as primary, while the natural dimension is portrayed as subsidiary [31]. In this way, the enhancement of the supernatural aspect of humanity leads to the establishment of balance in its natural dimension. The supernatural dimension encompasses psychological aspects, mental health, self-awareness, and theology, while the natural dimension pertains to the physical aspects of a person [31,32]. Most of the topics in the Qur'an are related to the human being in the context of the supernatural dimension of existence [33]. Since the Qur'an covers all dimensions of human life, naturally, the treatment of diseases can be another aspect of the countless verses of the Holy Qur'an [34]. In the Holy Qur'an, several verses highlight the healing properties of the Qur'an in treating various diseases, especially mental illnesses, referring to it as a "cure" or a healer of the heart. Examples include Asra'; 82, Younes; 57, Tubeh; 14, Nahl; 69, Shoara; 80, Fosselat; 44, and Eraf; 204 [9].

Previous research has shown that listening to the sound of the Quran can reduce the incidence of nervous problems and tension by 97% [34]. These results were obtained even in people who do not speak the Arabic language, as research shows that the human brain responds positively to sound stimuli with normal fluctuations [35]. The results of all studies in this field are in line with our findings, reporting the positive effect of religion on reducing people's anxiety and stress. With an overview of various studies conducted worldwide on Quran therapy, it appears that therapists have observed the effects of this intervention over time, leading to the design and implementation of studies.

The review showed that religiosity, particularly reciting the Holy Quran, is considered an effective intervention for reducing stress and anxiety in cancer patients, especially during their chemotherapy. Nevertheless, it is recommended to evaluate various aspects of education and treatment in the context of the Holy Quran to guide future research endeavors.

We would like to thank you from Ms. Massumeh Niazi for helping the data collection.

Conception and design: HM, and YR. Data collecting: FS, AS, ATNC. Supervision and writing the draft of the manuscript: HM, and YR. All authors contributed to helpful discussions, read and approved the final manuscript.

The authors declare that there are no conflicts of interest.

Not applicable.

None.

The authors declare that they have no competing interests.

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