• The introspective patient experience of mistletoe therapy in cancer: a qualitative study
• Effects of complementary mistletoe therapy on the quality of life of patients with breast, ovarian and non-small cell lung cancer – a prospective randomised controlled clinical trial

Mascher et al. 2023 [341]

Patients and methods

The introspective experience of cancer patients using mistletoe therapy is of central importance for a holistic understanding, but has been scientifically investigated to date rarely. In this qualitative, explorative, monocentric study, 20 outpatients with a history of various cancer types from a Swiss oncology centre were included. The primary aim was to investigate the introspective experience of the participants during mistletoe therapy. The patients included were 11 with breast cancer, three with prostate cancer, two with colorectal cancer, two with ovarian cancer and two with malignant melanoma. Eight patients were diagnosed with multiple cancers and/or metastases. Nineteen patients received other therapies such as allopathic or naturopathic medications, or dietary supplements at the time of the survey. Six patients also received oncological standard therapies.

Subcutaneous mistletoe therapy with Iscador was used for at least two years (median 7.5 years). The data were collected by two semi-structured, in-depth interviews per patient, the interviews were recorded and evaluated by qualitative content analysis. The individual experiences with mistletoe therapy were analysed in relation to six predefined dimensions of human experience such as the physical, vital, emotional, mental, spiritual, and social levels. In addition, the three cross-dimensional perspectives of warmth, immune strengthening, and general well-being were evaluated. 

Results

The data analysis showed a large spectrum of cancer patients' experiences with mistletoe therapy. Here, the importance of specific aspects such as increased vitality in order to cope with everyday life, greater emotional and mental stability, warmth as a multidimensional phenomenon, feelings of safety and protection through mistletoe therapy, increased self-awareness and improved self-care as well as a feeling of spiritual connection were clearly evident. The multi-layered feeling of warmth caused by mistletoe therapy, described by the participants, which not only included physical thermal well-being but also affected the emotional and spiritual levels, was particularly emphasised. The two latter ones were described as ‘warm feelings’ including a more conscious relationship to the body and increased body awareness. In addition, the participants highlighted the emotional aspect of the feeling of well-being caused by mistletoe therapy, as well as the feeling of confidence ‘from the outside’, which resulted in a further mobilisation of inner strengths such as self-confidence, self-efficacy, and a more conscious appreciation of oneself.

Conclusion

This study examined the observations made by cancer patients undergoing mistletoe therapy at different levels of experience. This results in a deeper understanding of the patients accompanying them during mistletoe therapy and throughout their overall patient journey. However, the results should be verified by further research on the effects of mistletoe therapy on an emotional, mental and spiritual level. For the initial evaluation as shown here, it would also be beneficial to transfer it into a clearly operationalisable concept through further psychometric studies.

Piao et al. 2004 [31]

Patients and methods

This multicentre, randomised, open, prospective, clinical trial, conducted according to good clinical Practice (GCP) criteria, examined the quality of life and tolerability of polychemotherapy in combination with mistletoe therapy.

The study included 233 patients with breast (n = 68), ovarian (n = 71) and non-small cell lung carcinoma (NSCLC, n = 94). Of the 233 patients originally recruited, 9 could not be included in the final evaluation because they did not meet the inclusion criteria in all respects, so that ultimately 224 patients were available for analysis.

All patients were treated with standard polychemotherapy. The verum group (n = 115) also received Helixor A subcutaneously three times a week in increasing doses from 1 mg to 200 mg. The control group (n = 109) received Lentinan, an immune stimulant commonly used in China and Japan with a proven effect on quality of life. The patients in both therapy arms were comparable with regard to gender, age, type of tumour, tumour stage and conventional therapies.

Quality of life was determined using three different, validated questionnaires or indices (functional living index-cancer = FLIC, Karnofski performance index = KPI, traditional Chinese medicine index = TCMI). The influence of mistletoe therapy on the tolerability of chemotherapy was investigated by group comparison of adverse events attributable to side effects of chemotherapy. The analyses were not performed separately for each tumour entity.

Results

Improvement of quality of life was significantly better under add-on mistletoe therapy compared to control therapy with add-on Lentinan (p < 0.05). There were also significantly fewer chemotherapy-related side effects under add-on mistletoe therapy. The Karnofsky index improved in 50.4 percent of patients in the verum group and in 32.4 percent in the control group, which was statistically significant (p = 0.002). 

As a result of mistletoe therapy, especially fatigue, insomnia, loss of appetite, nausea and pain improved. A total of 52 adverse events occurred in the mistletoe therapy group and 90 in the Lentinan group, 28 and 77, respectively, were chemotherapy-related; in 5 and 10 cases respectively, the course was severe.

Most mistletoe therapy-specific adverse events were overreactions at the injection site, which were self-limiting and did not need therapeutic intervention.

Conclusion

In this prospective randomised study conducted according to GCP-criteria, patients with breast, ovarian and non-small cell lung carcinoma showed a significant improvement in quality of life and a reduction in chemotherapy-related side effects when treated with chemotherapy plus mistletoe therapy compared to chemotherapy plus Lentinan.