Effect of Group-Based Dhikr Therapy on Health-Related Quality of Life (HRQoL) in Women with Breast Cancer: A Single-Center Randomized Controlled Trial
-
Ghasem Janbabaie
,
Mohammad Esmail Akbari
,
Zahra Salehi
,
Naeimeh Shahrabi Farahani
,
Zohreh Shahabi
,
Mostafa Qorbani
,
Afsaneh Sadat Makeh
,
Tahereh Rostami
,
Pouran Daboui
Abstract
Background: Breast cancer and its treatments significantly impair patients’ health-related quality of life (HRQoL). Spiritually oriented interventions, such as Dhikr therapy — the rhythmic recitation of Islamic holy words and phrases — aim to promote physiological and psychological relaxation. Although such approaches have shown promise in improving quality of life, evidence on structured, group-based Dhikr programs in oncology populations remains limited. This study aimed to evaluate the effectiveness of a six-session group-based Dhikr therapy program on HRQoL in women with breast cancer.
Materials and Methods: This two-arm, parallel-group randomized controlled trial included 60 women aged 25–55 years with confirmed breast cancer. Participants were randomly allocated (1:1) to either the intervention group (n=30), which received a structured 6-week group-based Dhikr therapy, or the control group (n=30), which received standard oncology care. The intervention consisted of weekly 90-minute sessions incorporating Quranic reflection, gratitude practice, guided visualization, and facilitated group sharing. The primary outcome was HRQoL, assessed using the EORTC QLQ-C30 and QLQ-BR23 questionnaires at baseline and within one week after intervention completion. The trial was registered with the institutional ethics committee (IR.SBMU.CRC.REC.1403.005). Statistical analysis was performed using SPSS v.31. Continuous data are presented as mean ± SD and categorical data as frequencies (%). Group differences were assessed with independent t-test, Mann–Whitney U, and chi-square tests as appropriate. Intervention effects on HRQoL were analyzed by two-way repeated-measures ANOVA. Significance was set at P ≤ 0.05.
Results: Compared with the control group, women in the Dhikr therapy group showed statistically significant improvements in all domains of the QLQ-C30: Symptom subscale (mean change: −17.40 vs. +9.38; P < 0.001), Function subscale (+9.58 vs. −20.08; P < 0.001), Single Items subscale (a global symptom index; −14.26 vs. +9.08; P < 0.001), and total score (intervention: 53.89 ± 32.51 to 75.83 ± 19.25; control: 70.28 ± 22.07 to 52.22 ± 16.07; P < 0.001). Similarly, the intervention group demonstrated significant improvements in the QLQ-BR23: Symptom subscale (−10.97 vs. +5.14; P = 0.001) and Function subscale (+15.41 vs. −32.91; P = 0.001), while the control group showed deterioration in both subscales.
Conclusion: A structured, group-based Dhikr therapy program improved both general and breast cancer-specific HRQoL among women with breast cancer. These findings support the integration of culturally appropriate spiritual interventions into standard supportive oncology care.
2. Daboui P, Akbari M, Khayamzadeh M, et al. Quality of Life and Hope Assessment in Women with Breast Cancer After Poetry Therapy as a Psychotherapy Method: A 6-Month Follow-Up Study. Int J Cancer Manag.2019;13(1): e96069
3. Hamid AA N, Akbari Shaye Y. Effectiveness of cognitive behavior therapy based on religious believes on hope and quality of life in the patients suffering breast cancer. HMJ. 2012;16(3):213-21.
4. Hamzehgardeshi Z, Moosazadeh M, Elyasi F, et al. Effect of Midwifery-Based Counseling Support Program on Body Image of Breast Cancer Women Survivors. Asian Pac J Cancer Prev. 2017;18(5):1293-9.
5. Javan Biparva A, Raoofi S, Rafiei S, et al. Global quality of life in breast cancer: systematic review and meta-analysis. BMJ Support Palliat Care. 2024;13(e3):e528-e36.
6. Mokhtari-Hessari P, Montazeri A. Health-related quality of life in breast cancer patients: review of reviews from 2008 to 2018. Health Qual Life Outcomes. 2020;18(1):338.
7. Zamaniyan S, Bolhari J, Naziri G, et al. Effectiveness of Spiritual Group Therapy on Quality of Life and Spiritual Well-Being among Patients with Breast Cancer. Iran J Med Sci. 2016;41(2):140-4.
8. Rezaei M, Elyasi F, Hamzehgardeshi Z, et al. Stress Management in Patients with Breast Cancer Using a Supportive Approach: A Systematic Review. Arch Breast Cancer. 2019:6(1):6-16.
9. Rezaei M, Elyasi F, Janbabai G, et al. Factors Influencing Body Image in Women with Breast Cancer: A Comprehensive Literature Review. Iran Red Crescent Med J. 2016;18(10):e39465.
10. Shapiro CL. Osteoporosis: A Long-Term and Late-Effect of Breast Cancer Treatments. Cancers (Basel). 2020;12(11):3094.
11. Van Dijck S, Nelissen P, Verbelen H, et al. The effects of physical self-management on quality of life in breast cancer patients: A systematic review. Breast. 2016;28:20-8.
12. Yan B, Yang LM, Hao LP, et al. Determinants of Quality of Life for Breast Cancer Patients in Shanghai, China. PLoS One. 2016;11(4):e0153714.
13. Salahinezhad M, kia B, Mahmoodi M, et al. The Effect of Spiritual Therapy on the Life Style of Hemodialysis Patients. Mil Caring Sci. 2021;8(2):193-201.
14. Henderson VP, Clemow L, Massion AO, et al. The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: a randomized trial. Breast Cancer Res Treat. 2012;131(1):99-109.
15. Cramer H, Lauche R, Klose P, et al. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev. 2017;1(1):Cd010802.
16. Hayes SC, Rye S, Disipio T, et al. Exercise for health: a randomized, controlled trial evaluating the impact of a pragmatic, translational exercise intervention on the quality of life, function and treatment-related side effects following breast cancer. Breast Cancer Res Treat. 2013;137(1):175-86.
17. Daboui P, Janbabai G, Akbari M, et al. Effect of Masnavi-based Poetry Therapy on Anxiety, Depression and Stress of Women with Breast Cancer. Iran J Psychiatry Behav Sci. 2022;16(4): e116651.
18. Leila S, Zahra P, Somayeh S, et al. Determining Laboratory Reference Values of TREC and KREC in Different Age Groups of Iranian Healthy Individuals. Iran J Allergy Asthma Immunol. 2019;18(2):143-152.
19. Chittick W. Me and Rumi: The Autobiography of Shams-i Tabrizi. Four Colour Imports, Ltd., Louisville, Kentucky, Fons Vitae. 2004.
20. vatankhah h. Determining the Effectiveness of Mantra Therapy on Measure of Delivering Anxiety in 1'st Pregnancy Women. J Police Med. 2017;6(1):43-56.
21. Rahimnejad A, Davati A, Garshasbi A. Relation between spiritual health and anxiety in pregnant women referred to Shaheed Mostafa Khomeini hospital in 2018. DANESHMED. 2020;27(1):11-18.
22. Yazdani A, Feizi P. The Study and Comparison of Tabatabaei and Plantinga's Viewpoint on Religious Diversity. COTH. 2010;1(1):109-124.
23. Sayyid Masoom H. Comprehensiveness of the Quran from the Viewpoint of Allameh Tabatabai. J Quran Knowl. 2013;4(14):7.
24. Valehi S, Hassanzadeh R. Comparative effect of aromatherapy with Citrus aurantium and mentioning on life expectancy of hemodialysis patients. IAHJ. 2019;4(2):7-13.
25. Heimes S. State of poetry therapy research (review). Arts Psychother 2011;38(1):1-8.
26. Raghuram TM. Poetry as therapy. Indian J Psychiatry. 2007;49(3):221-2.
27. Jafari N, Farajzadegan Z, Zamani A, et al. Spiritual therapy to improve the spiritual well-being of Iranian women with breast cancer: a randomized controlled trial. Evid Based Complement Alternat Med. 2013;2013:353262.
28. Koenig HG. Religion, spirituality, and health: the research and clinical implications. ISRN Psychiatry. 2012;2012:278730.
29. Oh PJ, Kim SH. The effects of spiritual interventions in patients with cancer: a meta-analysis. Oncol Nurs Forum. 2014;41(5):E290-301.
30. McLaren H, Patmisari E, Hamiduzzaman M, et al. Respect for Religiosity: Review of Faith Integration in Health and Wellbeing Interventions with Muslim Minorities. Religions. 2021;12(9):692.
31. T M, Z TF, K E, et al. Survey of quality of life of patients with breast cancer among women at Shahid Beheshti University of Medical science and Health service 2017. JHF. 2018;6(1):1-8.
32. Okviasanti F, Putra ST, Bakar A, et al. Effects of dhikr on spirituality and cortisol levels among patients with heart failure: a pilot study. JoViN. 2023;4(1):82-6.
33. Sulistyawati RA, Probosuseno, Setiyarini S. Dhikr Therapy for Reducing Anxiety in Cancer Patients. Asia Pac J Oncol Nurs. 2019;6(4):411-6.
34. Sun M, Tian X, Peng Y, et al. Effects of meaning therapy on spirituality, psychological health, and quality of life in patients with cancer: A systematic review and meta-analysis of randomized controlled trials. Asia Pac J Oncol Nurs. 2024;11(4):100388.
35. Izgu N, Metin ZG, Eroglu H, et al. Impact of spiritual interventions in individuals with cancer: A systematic review and meta-analysis. Eur J Oncol Nurs. 2024:71:102646.
36. Miller M, Meyers M, Krainak K, et al. Interventions to support spirituality among adults with cancer: a scoping review. Supportive Care Cancer. 2025;33(8):742.
37. Antoni MH, Lutgendorf SK, Cole SW, et al. The influence of bio-behavioural factors on tumour biology: pathways and mechanisms. Nat Rev Cancer. 2006;6(3):240-8.
38. Bhasin MK, Dusek JA, Chang BH, et al. Correction: relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretion and inflammatory pathways. Plos one. 2017;12(2):e0172873.
39. Koenig HG. Religion, spirituality, and health: The research and clinical implications. ISRN Psychiatry. 2012:2012:278730.
40. Lutgendorf SK, Sood AK, Antoni MH. Host factors and cancer progression: biobehavioral signaling pathways and interventions. J Clin Oncol. 2010;28(26):4094-9.
41. Reiche EMV, Nunes SOV, Morimoto HK. Stress, depression, the immune system, and cancer. Lancet Oncol. 2004;5(10):617-25.
42. Miller AH, Ancoli-Israel S, Bower JE, et al. Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol. 2008;26(6):971-82.
43. Bower JE. Cancer-related fatigue--mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014;11(10):597-609.
| Files | ||
| Issue | Vol 20 No 3 (2026) | |
| Section | Original Article(s) | |
| Keywords | ||
| Breast cancer; Dhikr therapy; Health-related quality of life; Randomized controlled trial | ||
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