Information for doctors

On these pages we have compiled some information which is essential for any doctor working with mistletoe. More information can be found on the website anthromedics.de

All information regarding the use of mistletoe therapy in various tumour entities can be found in the section Clinical Studies and Case Reports

Approval, indication, prescription, reimbursement Use of mistletoe therapy in oncology

 

Last update: May 5th, 2020/AB

Approval, indication, prescription, reimbursement

In Germany, the subcutaneous application of mistletoe is approved for adults. In accordance with the anthroposophic therapeutic concept and on the basis of the manufacturers' respective summary of product characteristics (SmPC), anthroposophic mistletoe therapy provides oncological patients with a "stimulation of formative and integrative forces to dissolve and reintegrate autonomous growth processes, e.g. in malignant tumour diseases, also with accompanying disorders of the haematopoietic organs; in benign tumour diseases; in defined precancerous lesions and for the prevention of recurrence after surgery" [1, 2, 3, 4]. This includes the application in all solid tumour entities and in all stages of disease.

The mistletoe preparations AbnobaVISCUM®, Helixor®, Iscador® and Iscucin® being produced according to anthroposophic principles are the most frequently prescribed preparations representing total plant extracts.

In Germany all four mistletoe preparations mentioned above are approved for use. Here the statutory health insurance reimburses the costs of mistletoe therapy with these drugs for all advanced, i.e. palliative, stages of disease on the condition of a prescription by a medical doctor. Precondition is a public health insurance prescription (Kassenrezept). The term palliative tumour therapy refers to the treatment of a disease which is not yet final, but which can no longer be treated curatively. The aim of this therapy is to alleviate the symptoms, improve quality of life and, if possible, to extend survival time [5].

In an adjuvant, i.e. non-metastatic stage of cancer, statutory and private insurance companies have the option to cover the costs, but aren’t required to do so. Exceptional cases of severe side effects during or after chemotherapy, such as cancer-related fatigue syndrome, may justify coverage by German statutory health insurance.

In Austria approval exists only for Helixor® and Iscador®. Here, the costs for these preparations are covered in palliative situations and, with detailed justification, also for adjuvant use, depending on the health insurance company. In addition, another mistletoe preparation, Isorel®, has received so-called upright approval in Austria. In all probability, this preparation will be generally available there from spring 2021. 

In Switzerland, too, only Helixor® and Iscador® are officially approved and only available upon prescription by a medical doctor. They are covered by basic insurance.

 

Last update: May 5th, 2020/AB

Use of mistletoe therapy in oncology

Anthroposophic mistletoe therapy is widely used. Preparations of white-berry European mistletoe (Viscum album L.) are among the most frequently prescribed medicines for cancer  [6, 7]. Up to 80 percent of these patients use complementary therapies [8, 9, 10, 11, 12] and up to 62 percent explicitly use mistletoe therapy [13, 14, 15, 16, 17, 18, 19].

There are marked national differences in the prevalence of mistletoe therapy. The physician's recommendation plays an important role here, as patients' need for information on mistletoe therapy is high just as is the case in other complementary therapies [20].

Unless otherwise prescribed, the mistletoe preparation is injected subcutaneously two to three times a week. The optimal strength and dose are determined by the physician, taking into account the possible reactions to mistletoe administration and contraindications. Dosage, frequency and duration of use depend on the condition of the person to be treated, their reaction, the clinical course of the disease and the respective mistletoe preparation. The dosage is gradually increased and is based on the individual's general condition, the strength of the reaction at the injection site and body temperature. Usually, mistletoe can be applied at various locations, e.g. alternately to the four quadrants of the abdominal skin, the thigh or upper arm. Inflamed or irradiated application sites should always be avoided. The time of day for the administration of mistletoe can be determined individually.

The duration of use is principally not limited and should be discussed between doctor and patient. It depends on the respective risk of recurrence and the individual condition and diagnostic findings of the patient. The application can last for a long period of time, continuously or intermittently. Usually, pauses are taken with increasing duration of therapy [1, 2, 3, 4].

Mistletoe treatment can be continued without any problems during holidays or travel. The mistletoe ampoules can be carried in small cool packs in the hand luggage. For this purpose, a certificate from the attending physician on the ongoing therapy is required in order to be allowed to take the ampoules as additional liquids in hand luggage. At the destination they should be stored in the refrigerator at 2-8 °C (35-46 °F).

High-dosage or off-label use of mistletoe applications (e.g. intravenous, intrapleural, intravascular, intrapericardial, intratumoural and intraperitoneal mistletoe applications) in addition to usual subcutaneous injections should be reserved for specialists and should be carried out under close clinical observation  [22]. These applications are off-label, as they are outside the scope of authority’s approval. This requires the patient’s written consent. However, these off-label ways of administering are generally considered to be safe (please also read the section on safety).

Further information on the use of mistletoe can be found at anthromedics

 

Last update: May 5th, 2020/AB

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