German S3 Guideline on Complementary Medicine in the Treatment of Oncological Patients

The German S3 Guideline on Complementary Medicine in the Treatment of Oncological Patients has been established as a joint project of the German Association of the Scientific Medical Societies, the German Cancer Society and the German Cancer Aid. The current version of this guideline has been released in September 2021. In addition to cancer therapy associated symptoms and health related quality of life, it provides information on evidence-based complementary whole medical systems (e.g. acupuncture), mind-body procedures (e.g. meditation), manipulative body therapies (e.g. Reiki) and biological therapies, under which, among other things, the medicinal products containing mistletoe whole extract (Viscum album L.) are classified.

Recommendation 7.65 of this guideline indicates that subcutaneous administration of medicinal products containing mistletoe whole extract (Viscum album L.) can be used for therapeutic use to improve the global quality of life in patients with solid tumors (recommendation grade 0, evidence level 1a, Chapter 7.17.11, page 440 of the long version of the S3-guideline). The following sources were used for this recommendation: Freuding et al. 2019, Horneber et al. 2008, Kienle and Kiene 2010, and Büssing et al. 2012.

Statement 7.64 of the guideline further states that currently no recommendation can be made for or against prescribing medicinal products containing mistletoe extract (Viscum album L.) with the aim of prolonging survival of cancer patients (evidence level 1a, Chapter 7.17.11, page 440 of the current long version) because, according to the authors, the currently available data are insufficient for a conclusive assessment. This statement is based on the following references: Freuding et al. 2019, Ostermann et al. 2009, Ostermann et al. 2020, and Horneber et al. 2008.

According to the authors, 5 systematic reviews and 5 meta-analyses from the entire available mistletoe literature were included for the evidence review of the above recommendation and statement on mistletoe therapy. The underlying methodology is laid down under the following points: in the guideline report under point 4 on page 30 as well as under point 11.2.17 as a flowchart (Figure 18) and in the long version of the S3 guideline under point 7.17.11 on page 441.

Appendix 11 of the long version of the S3 guideline presents a questionnaire for the structured recording of the use of complementary medical procedures and methods, which can be downloaded as a word version on the guideline program page. Here, a two-page list is presented in which the patient can tick the complementary medical procedures and methods currently used, give comments and express a wish for consultation. For mistletoe, as for 21 other procedures and methods, the guideline recommends in this questionnaire that patients talk to a physician about taking it.

 

Last update: 20. Oktober 2021/ AT

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