Mistletoe in oncological treatment: a systematic review
One important goal of any cancer therapy is to improve or maintain quality of life. In this context, mistletoe treatment is discussed to be highly controversial. The aim of this systematic review is to give an extensive overview about the current state of evidence concerning mistletoe therapy of oncologic patients regarding quality of life and side effects of cancer treatments.
In September and October 2017, Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL and “Science Citation Index Expanded” (Web of Science) were systematically searched.
The search strategy identified 3647 articles and 28 publications with 2639 patients were finally included in this review. Mistletoe was used in bladder cancer, breast cancer, other gynecological cancers (cervical cancer, corpus uteri cancer, and ovarian cancer), colorectal cancer, other gastrointestinal cancer (gastric cancer and pancreatic cancer), glioma, head and neck cancer, lung cancer, melanoma and osteosarcoma. In nearly all studies, mistletoe was added to a conventional therapy. Regarding quality of life, 17 publications reported results. Studies with better methodological quality show less or no effects on quality of life.
With respect to quality of life or reduction of treatment-associated side effects, a thorough review of the literature does not provide any indication to prescribe mistletoe to patients with cancer.
KeywordsMistletoe Cancer Complementary and alternative medicine (CAM) Patient-relevant outcomes
The authors want to thank Dajana Daum, Catalina Hoppe, Gunnar Voß and Louisa Wortmann for supporting in data extraction/data management and duplicate search.
The work of MF was funded in parts (search of the literature, title-abstract screening) by the German Guideline “S3 Leitlinie Komplementärmedizin in der Behandlung von onkologischen PatientInnen (Registernummer 032-055OL)” funded by the German Cancer Aid (Fördernummer 11583) within the German Guideline Program in Oncology. Furthermore, the work of MF was funded in parts (evidence table) by the working group Prevention and Integrative Oncology of the German Cancer Society.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
- Bar-Sela G, Wollner M, Hammer L, Agbarya A, Dudnik E, Haim N (2013) Mistletoe as complementary treatment in patients with advanced non-small-cell lung cancer treated with carboplatin-based combinations: a randomised phase II study European. J Cancer 49:1058–1064Google Scholar
- Grossarth-Maticek R, Ziegler R (2006a) Prospective controlled cohort studies on long-term therapy of breast cancer patients with a mistletoe preparation (Iscador). Forschende Komplementarmedizin (2006) 13:285–292Google Scholar
- Grossarth-Maticek R, Ziegler R (2006b) Randomised and non-randomised prospective controlled cohort studies in matched-pair design for the long-term therapy of breast cancer patients with a mistletoe preparation (Iscador): a re-analysis. Eur J Med Res 11:485–495Google Scholar
- Grossarth-Maticek R, Ziegler R (2007b) Prospective controlled cohort studies on long-term therapy of cervical cancer patients with a mistletoe preparation (Iscador). Forschende Komplementarmedizin (2006) 14:140–147Google Scholar
- Grossarth-Maticek R, Ziegler R (2007c) Prospective controlled cohort studies on long-term therapy of ovairian cancer patients with mistletoe (Viscum album L.) extracts iscador. Arzneimittelforschung 57:665–678Google Scholar
- Grossarth-Maticek R, Ziegler R (2008) Randomized and non-randomized prospective controlled cohort studies in matched pair design for the long-term therapy of corpus uteri cancer patients with a mistletoe preparation (Iscador). Eur J Med Res 13:107–120Google Scholar
- Heiny BM, Albrecht V (1997) Complementary modes of therapy with mistletoe lectin-1. Medizinische Welt 48:419–423Google Scholar
- Hübner J (2015) Comment on ‘Quality of life of patients with advanced pancreatic cancer during treatment with mistletoe: a randomized controlled trial: several flaws. Deutsches Arzteblatt International 112:9–9Google Scholar
- Huebner J et al (2014) User rate of complementary and alternative medicine (CAM) of patients visiting a counseling facility for CAM of a German comprehensive cancer center. Anticancer Res 34:943–948Google Scholar
- Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed) Evaluation of chemotherapeutic agents. Columbia Univ Press, New York, pp 191–205Google Scholar
- Khan FA, Akhtar SS, Sheikh MK (2005) Cancer treatment—objectives and quality of life issues Malays. J Med Sci 12:3–5Google Scholar
- Kienle GS, Kiene H (2007) Complementary cancer therapy: a systematic review of prospective clinical trials on anthroposophic mistletoe extracts. Eur J Med Res 12:103–119Google Scholar
- Kleeberg UR et al (2004) Final results of the EORTC 18871/DKG 80-1 randomised phase III trial. rIFN-alpha2b versus rIFN-gamma versus ISCADOR M versus observation after surgery in melanoma patients with either high-risk primary (thickness> 3 mm) or regional lymph node metastasis. Eur J Cancer 40:390–402CrossRefGoogle Scholar
- Lange-Lindberg A-M, Velasco Garrido M, Busse R (2006) Mistletoe treatments for minimising side effects of anticancer chemotherapy. GMS Health Technol Assess 2:1–8Google Scholar
- Lenartz D, Stoffel B, Menzel J, Beuth J (1996) Immunoprotective activity of the galactoside-specific lectin from mistletoe after tumor destructive therapy in glioma patients. Anticancer Res 16:3799–3802Google Scholar
- Lenartz D, Dott U, Menzel J, Schierholz JM, Beuth J (2000) Survival of glioma patients after complementary treatment with galactoside-specific lectin from mistletoe. Anticancer Res 20:2073–2076Google Scholar
- Melzer J, Iten F, Hostanska K, Saller R (2009) Efficacy and safety of mistletoe preparations (Viscum album) for patients with cancer diseases. A systematic review. Forschende Komplementarmedizin (2006) 16:217–226Google Scholar
- Piao BK, Wang YX, Xie GR, Mansmann U, Matthes H, Beuth J, Lin HS (2004) Impact of complementary mistletoe extract treatment on quality of life in breast, ovarian and non-small cell lung cancer patients. A prospective randomized controlled clinical trial. Anticancer Res 24:303–309Google Scholar
- Semiglasov VF, Stepula VV, Dudov A, Lehmacher W, Mengs U (2004) The standardised mistletoe extract PS76A2 improves QoL in patients with breast cancer receiving adjuvant CMF chemotherapy: a randomised, placebo-controlled, double-blind, multicentre clinical trial. Anticancer Res 24:1293–1302Google Scholar
- Semiglazov VF, Stepula VV, Dudov A, Schnitker J, Mengs U (2006) Quality of life is improved in breast cancer patients by Standardised Mistletoe Extract PS76A2 during chemotherapy and follow-up: a randomised, placebo-controlled, double-blind, multicentre clinical trial. Anticancer Res 26:1519–1529Google Scholar
- Steuer-Vogt MK et al (2001) The effect of an adjuvant mistletoe treatment programme in resected head and neck cancer patients: a randomised controlled clinical trial European. J Cancer 37:23–31Google Scholar
- Stub T, Quandt SA, Arcury TA, Sandberg JC, Kristoffersen AE, Musial F, Salamonsen A (2016) Perception of risk and communication among conventional and complementary health care providers involving cancer patients’ use of complementary therapies: a literature review. BMC Complement Altern Med 16:353. https://doi.org/10.1186/s12906-016-1326-3 CrossRefGoogle Scholar
- Troger W, Jezdic S, Zdrale Z, Tisma N, Hamre HJ, Matijasevic M (2009) Quality of life and neutropenia in patients with early stage breast cancer: a randomized pilot study comparing additional treatment with mistletoe extract to chemotherapy alone Breast cancer. Basic Clin Res 3:35–45Google Scholar
- Troger W, Zdrale Z, Stankovic N, Matijasevic M (2012) Five-year follow-up of patients with early stage breast cancer after a randomized study comparing additional treatment with Viscum album (L.) extract to chemotherapy alone. Breast Cancer Basic Clin Res 6:173–180. https://doi.org/10.4137/BCBCR.S10558 CrossRefGoogle Scholar
- Troger W, Galun D, Reif M, Schumann A, Stankovic N, Milicevic M (2014a) Quality of life of patients with advanced pancreatic cancer during treatment with mistletoe: a randomized controlled trial. Deutsches Arzteblatt international 111:493–502 (433 p following 502) Google Scholar
- Troger W, Zdrale Z, Tisma N, Matijasevic M (2014b) Additional therapy with a mistletoe product during adjuvant chemotherapy of breast cancer patients improves quality of life: an open randomized clinical pilot trial. Evid Based Complement Altern Med eCAM 2014:430518. https://doi.org/10.1155/2014/430518 CrossRefGoogle Scholar
- WHO (1996) What quality of life? The WHOQOL Group. World Health Organization Quality of Life. Assessment World Health Forum 17:354–356Google Scholar