BackgroundDuring the last two decades, there have been spiritual/religious interventions in cancer patients to prevent or treat a range of physical problems, including managing chronic pain, coping with the disease, boosting hope and mental health. Although societies are of different faiths and belief systems, what they all share is spirituality.ObjectivesUpon this we put forward the hypothesis of changes in gene receptor expressions as a result of spiritual intervention for the first time in the world.Materials and MethodsIn this study, the spiritual intervention was conducted on 57 volunteer females with early breast cancer involvement. Blood samples were collected prior to and after the spiritual intervention to analyze the changes in dopamine gene receptor expressions as the main site of effect. In order to administer the spiritual intervention backed by Quran, Islam and international standards, issues, with emphasis on peace, human growth and perfection, accepting God as an eternal source of power and kindness to build trust and reduce stress, were selected. They included prayer, patience, reliance, self-sacrifice and forgiveness, altruism and kindness, remission and repentance, thankfulness, zikr (mantra), meditation, and death concept.ResultsObtained results from peripheral blood mononuclear cell samples analyzed by real time-PCR showed significant reduction in dopamine gene receptor (DRD1-5) expressions in comparison with those of pre-test scores and the control group.ConclusionsSpiritual intervention based on Islamic principals can bring back mental health, increase hope and quality of life and eventually change dopamine gene receptor expressions resulting in reduction of cell proliferation, thus better prevention and management in breast cancer patients compared to other forms of treatment.

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Breast cancer is the most common cancer in females in Iran and in most of the developed countries. Studies have shown that having chronic stress in individuals predisposes several types of cancer including breast cancer. Research results showed that spiritual factors correlate with indices of physical consequences such as heart disease, cancer, and death, so do psychiatric conditions and changes in receptor gene expression in depression, anxiety, and social dysfunction. Different studies demonstrated the role of neurotransmitters in occurrence and progression of cancers. They affected cells by their various types of receptors. An effective gene in mental and physical conditions is Dopamine receptor. Accordingly, the study was conducted to evaluate effects of psychotherapy (spiritual intervention) on changes in Dopamine receptor gene expressions in breast cancer patients. 90 female volunteers, including 30 healthy individuals and 60 diagnosed with breast cancer, considering exclusion criteria, were selected for the purpose of the study. The breast cancer patients were further categorized into experimental and control groups of 30 each. Blood samples were collected both prior to and following the spiritual intervention to analyze changes in their dopamine gene receptor expressions. We observed that DRD2-DRD4 in the control group (breast cancer patients) PBMC increased compared to healthy individuals. Also, DRD2-DRD4 in intervention group PBMC decreased compared to the control group and to even lower than those of healthy individuals. The findings were of great significance in management and treatment of cancer because they revealed the possibility of using alternative treatments (e.g., spiritual interventions) apart from conventional medical treatments.

This article investigates ethical challenges cancer patients face in the end stages of life including doctors' responsibilities, patients' rights, unexpected desires of patients and their relatives, futile treatments, and communication with patients in end stages of life. These patients are taken care of through palliative rather than curative measures. In many cases, patients in the last days of life ask their physician to terminate their illness via euthanasia which has many ethical considerations. Proponents of such mercy killing (euthanasia) believe that if the patient desires, the physician must end the life, while opponents of this issue, consider it as an act of murder incompatible with the spirit of medical sciences. The related arguments presented in this paper and other ethical issues these patients face and possible solutions for dealing with them have been proposed. It should be mentioned that this paper is more human rational and empirical and the views of the legislator are not included, though in many cases human intellectual and empirical comments are compatible with those of the legislator.

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