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Published in: Journal of Cancer Research and Clinical Oncology 4/2019

01-04-2019 | Review – Clinical Oncology

Mistletoe in oncological treatment: a systematic review

Part 2: quality of life and toxicity of cancer treatment

Authors: M. Freuding, C. Keinki, S. Kutschan, O. Micke, J. Buentzel, Jutta Huebner

Published in: Journal of Cancer Research and Clinical Oncology | Issue 4/2019

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.
Appendix
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Literature
go back to reference Aaronson NK et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRefPubMed Aaronson NK et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRefPubMed
go back to reference 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 49:1058–1064 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 49:1058–1064
go back to reference Cazacu M et al (2003) The influence of isorel on the advanced colorectal cancer. Cancer Biother Radiopharm 18:27–34CrossRefPubMed Cazacu M et al (2003) The influence of isorel on the advanced colorectal cancer. Cancer Biother Radiopharm 18:27–34CrossRefPubMed
go back to reference Coates A, Glasziou P, McNeil D (1990) On the receiving end—III. Measurement of quality of life during cancer chemotherapy. Ann Oncol 1:213–217CrossRefPubMed Coates A, Glasziou P, McNeil D (1990) On the receiving end—III. Measurement of quality of life during cancer chemotherapy. Ann Oncol 1:213–217CrossRefPubMed
go back to reference El-Kolaly RM, Abo-Elnasr M, El-Guindy D (2016) Outcome of pleurodesis using different agents in management of malignant pleural effusion Egyptian. J Chest Dis Tuberc 65:435–440CrossRef El-Kolaly RM, Abo-Elnasr M, El-Guindy D (2016) Outcome of pleurodesis using different agents in management of malignant pleural effusion Egyptian. J Chest Dis Tuberc 65:435–440CrossRef
go back to reference Ernst E, Schmidt K, Steuer-Vogt MK (2003) Mistletoe for cancer? A systematic review of randomised clinical trials. Int J Cancer 107(2):262–267CrossRefPubMed Ernst E, Schmidt K, Steuer-Vogt MK (2003) Mistletoe for cancer? A systematic review of randomised clinical trials. Int J Cancer 107(2):262–267CrossRefPubMed
go back to reference Goebell PJ, Otto T, Suhr J, Rubben H (2002) Evaluation of an unconventional treatment modality with mistletoe lectin to prevent recurrence of superficial bladder cancer: a randomized phase II trial. J Urol 168:72–75CrossRefPubMed Goebell PJ, Otto T, Suhr J, Rubben H (2002) Evaluation of an unconventional treatment modality with mistletoe lectin to prevent recurrence of superficial bladder cancer: a randomized phase II trial. J Urol 168:72–75CrossRefPubMed
go back to reference 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) 13:285–292 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) 13:285–292
go back to reference 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 11:485–495PubMed 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 11:485–495PubMed
go back to reference Grossarth-Maticek R, Ziegler R (2007a) Efficacy and safety of the long-term treatment of melanoma with a mistletoe preparation (Iscador). Schweizerische Zeitschrift fur GanzheitsMedizin 19:325–332CrossRef Grossarth-Maticek R, Ziegler R (2007a) Efficacy and safety of the long-term treatment of melanoma with a mistletoe preparation (Iscador). Schweizerische Zeitschrift fur GanzheitsMedizin 19:325–332CrossRef
go back to reference 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) 14:140–147 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) 14:140–147
go back to reference 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 57:665–678PubMed 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 57:665–678PubMed
go back to reference 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 13:107–120PubMed 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 13:107–120PubMed
go back to reference Grossarth-Maticek R, Eysenck HJ, Boyle GJ (1995) Method of test administration as a factor in test validity: the use of a personality questionnaire in the prediction of cancer and coronary heart disease. Behav Res Ther 33:705–710CrossRefPubMed Grossarth-Maticek R, Eysenck HJ, Boyle GJ (1995) Method of test administration as a factor in test validity: the use of a personality questionnaire in the prediction of cancer and coronary heart disease. Behav Res Ther 33:705–710CrossRefPubMed
go back to reference Heiny BM, Albrecht V (1997) Complementary modes of therapy with mistletoe lectin-1. Medizinische Welt 48:419–423 Heiny BM, Albrecht V (1997) Complementary modes of therapy with mistletoe lectin-1. Medizinische Welt 48:419–423
go back to reference 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 112:9–9PubMedPubMedCentral 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 112:9–9PubMedPubMedCentral
go back to reference 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 34:943–948PubMed 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 34:943–948PubMed
go back to reference 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 191–205 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 191–205
go back to reference Khan FA, Akhtar SS, Sheikh MK (2005) Cancer treatment—objectives and quality of life issues Malays. J Med Sci 12:3–5 Khan FA, Akhtar SS, Sheikh MK (2005) Cancer treatment—objectives and quality of life issues Malays. J Med Sci 12:3–5
go back to reference Kienle GS, Kiene H (2007) Complementary cancer therapy: a systematic review of prospective clinical trials on anthroposophic mistletoe extracts. Eur J Med Res 12:103–119PubMed Kienle GS, Kiene H (2007) Complementary cancer therapy: a systematic review of prospective clinical trials on anthroposophic mistletoe extracts. Eur J Med Res 12:103–119PubMed
go back to reference Kienle GS, Kiene H (2010) Review article: influence of Viscum album L (European mistletoe) extracts on quality of life in cancer patients: a systematic review of controlled clinical studies. Integr Cancer Ther 9:142–157CrossRefPubMed Kienle GS, Kiene H (2010) Review article: influence of Viscum album L (European mistletoe) extracts on quality of life in cancer patients: a systematic review of controlled clinical studies. Integr Cancer Ther 9:142–157CrossRefPubMed
go back to reference Kienle GS, Glockmann A, Schink M, Kiene H (2009) Viscum album L. extracts in breast and gynaecological cancers: a systematic review of clinical and preclinical research. J Exp Clin Cancer Res 28:79CrossRefPubMedPubMedCentral Kienle GS, Glockmann A, Schink M, Kiene H (2009) Viscum album L. extracts in breast and gynaecological cancers: a systematic review of clinical and preclinical research. J Exp Clin Cancer Res 28:79CrossRefPubMedPubMedCentral
go back to reference Kim KC, Yook JH, Eisenbraun J, Kim BS, Huber R (2012) Quality of life, immunomodulation and safety of adjuvant mistletoe treatment in patients with gastric carcinoma—a randomized, controlled pilot study. BMC Complement Altern Med 12:172CrossRefPubMedPubMedCentral Kim KC, Yook JH, Eisenbraun J, Kim BS, Huber R (2012) Quality of life, immunomodulation and safety of adjuvant mistletoe treatment in patients with gastric carcinoma—a randomized, controlled pilot study. BMC Complement Altern Med 12:172CrossRefPubMedPubMedCentral
go back to reference 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 40:390–402CrossRef 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 40:390–402CrossRef
go back to reference Lange-Lindberg A-M, Velasco Garrido M, Busse R (2006) Mistletoe treatments for minimising side effects of anticancer chemotherapy. GMS Health Technol Assess 2:1–8 Lange-Lindberg A-M, Velasco Garrido M, Busse R (2006) Mistletoe treatments for minimising side effects of anticancer chemotherapy. GMS Health Technol Assess 2:1–8
go back to reference 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 16:3799–3802PubMed 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 16:3799–3802PubMed
go back to reference 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 20:2073–2076PubMed 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 20:2073–2076PubMed
go back to reference Longhi A, Mariani E, Kuehn J (2009) A randomized study with adjuvant mistletoe versus oral Etoposide on post relapse disease-free survival in osteosarcoma patients. Eur J Integr Med 1:31–39CrossRef Longhi A, Mariani E, Kuehn J (2009) A randomized study with adjuvant mistletoe versus oral Etoposide on post relapse disease-free survival in osteosarcoma patients. Eur J Integr Med 1:31–39CrossRef
go back to reference 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) 16:217–226 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) 16:217–226
go back to reference 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 24:303–309PubMed 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 24:303–309PubMed
go back to reference 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 24:1293–1302PubMed 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 24:1293–1302PubMed
go back to reference 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 26:1519–1529PubMed 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 26:1519–1529PubMed
go back to reference Spitzer WO et al (1981) Measuring the quality of life of cancer patients: a concise QL-index for use by physicians. J Chronic Dis 34:585–597CrossRefPubMed Spitzer WO et al (1981) Measuring the quality of life of cancer patients: a concise QL-index for use by physicians. J Chronic Dis 34:585–597CrossRefPubMed
go back to reference 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 37:23–31 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 37:23–31
go back to reference Steuer-Vogt MK, Bonkowsky V, Scholz M, Fauser C, Licht K, Ambrosch P (2006) Influence of ML-1 standardized mistletoe extract on the quality of life in head and neck cancer patients. Hno 54:277–286CrossRefPubMed Steuer-Vogt MK, Bonkowsky V, Scholz M, Fauser C, Licht K, Ambrosch P (2006) Influence of ML-1 standardized mistletoe extract on the quality of life in head and neck cancer patients. Hno 54:277–286CrossRefPubMed
go back to reference 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 3:35–45 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 3:35–45
go back to reference 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 CrossRef 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 CrossRef
go back to reference Troger W, Galun D, Reif M, Schumann A, Stankovic N, Milicevic M (2013) Viscum album [L.] extract therapy in patients with locally advanced or metastatic pancreatic cancer: a randomised clinical trial on overall survival. Eur J Cancer 49:3788–3797CrossRefPubMed Troger W, Galun D, Reif M, Schumann A, Stankovic N, Milicevic M (2013) Viscum album [L.] extract therapy in patients with locally advanced or metastatic pancreatic cancer: a randomised clinical trial on overall survival. Eur J Cancer 49:3788–3797CrossRefPubMed
go back to reference 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) PubMedPubMedCentral 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) PubMedPubMedCentral
go back to reference 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 CrossRef 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 CrossRef
go back to reference Troger W, Zdrale Z, Stankovic N (2016) Five-Year follow-up of patients with early stage breast cancer after a randomized study with Viscum album (L.) extract. Deutsche Zeitschrift fur Onkologie 48:105–110CrossRef Troger W, Zdrale Z, Stankovic N (2016) Five-Year follow-up of patients with early stage breast cancer after a randomized study with Viscum album (L.) extract. Deutsche Zeitschrift fur Onkologie 48:105–110CrossRef
go back to reference WHO (1996) What quality of life? The WHOQOL Group. World Health Organization Quality of Life. Assessment World Health Forum 17:354–356 WHO (1996) What quality of life? The WHOQOL Group. World Health Organization Quality of Life. Assessment World Health Forum 17:354–356
Metadata
Title
Mistletoe in oncological treatment: a systematic review
Part 2: quality of life and toxicity of cancer treatment
Authors
M. Freuding
C. Keinki
S. Kutschan
O. Micke
J. Buentzel
Jutta Huebner
Publication date
01-04-2019
Publisher
Springer Berlin Heidelberg
Published in
Journal of Cancer Research and Clinical Oncology / Issue 4/2019
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI
https://doi.org/10.1007/s00432-018-02838-3

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