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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
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 85:365–376
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
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424. https://doi.org/10.3322/caac.21492
Bussing A, Raak C, Ostermann T (2012) Quality of life and related dimensions in cancer patients treated with mistletoe extract (iscador): a meta-analysis. Evid Based Complement Altern Med eCAM 2012:219402. https://doi.org/10.1155/2012/219402
Cazacu M et al (2003) The influence of isorel on the advanced colorectal cancer. Cancer Biother Radiopharm 18:27–34
Cella DF et al (1993) The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579. https://doi.org/10.1200/jco.19220.127.116.110
Coates A, Glasziou P, McNeil D (1990) On the receiving end—III. Measurement of quality of life during cancer chemotherapy. Ann Oncol 1:213–217
Deutschinoff G, Friedrich C, Dott U, Voigtmann R, Pientka L (2005) Lebensqualität in der Onkologie—Status Quo und Ausblick [Quality of life in oncology—status quo and outlook]. Der Onkologe 11:164–172. https://doi.org/10.1007/s00761-004-0825-x
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 65:435–440
Ernst E, Schmidt K, Steuer-Vogt MK (2003) Mistletoe for cancer? A systematic review of randomised clinical trials. Int J Cancer 107(2):262–267
Gaafar R, Abdel Rahman ARM, Aboulkasem F, El Bastawisy A (2014) Mistletoe preparation (Viscum Fraxini-2) as palliative treatment for malignant pleural effusion: a feasibility study with comparison to bleomycin. Ecancermedicalscience 8:424. https://doi.org/10.3332/ecancer.2014.424
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 168:72–75
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 (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 11:485–495
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 19:325–332
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 (2007c) Prospective controlled cohort studies on long-term therapy of ovairian cancer patients with mistletoe (Viscum album L.) extracts iscador. Arzneimittelforschung 57:665–678
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 13:107–120
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 33:705–710
Heiny BM, Albrecht V (1997) Complementary modes of therapy with mistletoe lectin-1. Medizinische Welt 48:419–423
Horneber MA, Bueschel G, Huber R, Linde K, Rostock M (2008) Mistletoe therapy in oncology. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003297
Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M (2012) How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr Cancer Ther 11:187–203. https://doi.org/10.1177/1534735411423920
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 112:9–9
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 34:943–948
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
Khan FA, Akhtar SS, Sheikh MK (2005) Cancer treatment—objectives and quality of life issues Malays. J Med Sci 12:3–5
Kienle GS, Kiene H (2007) Complementary cancer therapy: a systematic review of prospective clinical trials on anthroposophic mistletoe extracts. Eur J Med Res 12:103–119
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 9:142–157
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 28:79
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 12:172
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 40:390–402
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
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 16:3799–3802
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 20:2073–2076
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 1:31–39
Longhi A, Reif M, Mariani E, Ferrari S (2014) A randomized study on postrelapse disease-free survival with adjuvant mistletoe versus oral etoposide in osteosarcoma patients. Evid Based Complement Altern Med eCAM 2014:210198. https://doi.org/10.1155/2014/210198
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
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 24:303–309
Schipper H, Clinch J, McMurray A, Levitt M (1984) Measuring the quality of life of cancer patients: the Functional Living Index-Cancer: development and validation. J Clin Oncol 2:472–483. https://doi.org/10.1200/jco.1918.104.22.1682
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 24:1293–1302
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 26:1519–1529
Spitzer WO et al (1981) Measuring the quality of life of cancer patients: a concise QL-index for use by physicians. J Chronic Dis 34:585–597
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, 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 54:277–286
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
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, 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
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 49:3788–3797
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)
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
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 48:105–110
WHO (1996) What quality of life? The WHOQOL Group. World Health Organization Quality of Life. Assessment World Health Forum 17:354–356
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.
Conflict of interest
The authors declare no conflict of interest.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Freuding, M., Keinki, C., Kutschan, S. et al. Mistletoe in oncological treatment: a systematic review. J Cancer Res Clin Oncol 145, 927–939 (2019). https://doi.org/10.1007/s00432-018-02838-3
- Complementary and alternative medicine (CAM)
- Patient-relevant outcomes