MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Many cancer patients use mistletoe extracts either hoping to cure their cancer or to alleviate its symptoms. The evidence that mistletoe treatment (MT) can achieve either of these goals is mixed but, on the whole, however, it is not positive. Our own systematic review of 2003 concluded that ‘rigorous trials of mistletoe extracts fail to demonstrate efficacy of this therapy’. The more recent Cochrane review concurred: ‘The evidence from RCTs to support the view that the application of mistletoe extracts has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak.’

Patients’ experiences of side effects and the acceptability, tolerability, and perceived benefits of MT have not been assessed critically. The aim of this new article was to systematically review and synthesise the results of qualitative studies of cancer patients’ experiences of using MT.

Electronic searches were conducted in MEDLINE, Embase, PsychLIT, CINAHL, and AMED to identify all qualitative studies of MT. Articles were screened independently by two reviewers and critically appraised using the Critical Appraisal Skills Programme tool. A thematic synthesis of the findings was carried out.

One hundred and seventy-three papers were identified; 156 were excluded at initial screening. Seventeen papers were read in full, 14 of which were excluded. Three articles about patients’ experiences of MT alongside conventional treatment were included in the synthesis, either as a monotherapy (two articles) or as part of a package of anthroposophic treatment (one article). Patients reported demonstrable changes to their physical, emotional, and psychosocial well-being following MT, as well as a reduction in chemotherapy side effects. Self-reported side effects from MT were few, and the studies suggest good adherence to the therapy. Self-injection gave patients a sense of empowerment through involvement in their own treatment.

The authors concluded that ‘given the variation in context of MT delivery across the articles, it is not possible to ascribe changes in patients’ quality of life specifically to MT.’

This might be a polite way of saying that there is no good evidence to suggest that MT positively affects patients’ experiences of side effects and the acceptability, tolerability, and perceived benefits.

Mistletoe is, of course, the ‘flagship’ intervention of Rudolf Steiner’s anthroposophical medicine. About a century ago, his idea was simple (or should this be ‘simplistic’?): the mistletoe plant is a parasite that lives off host trees sapping its resources until, eventually, it might even kill its host – just like cancer threatening the life of a human being. It follows, according to the homeopathy-inspired Steiner and the many followers of his cult that mistletoe is an effective cancer therapy.

Despite the weirdness of this concept and the largely negative evidence, MT is hugely popular as a cancer cure, particularly in German-speaking countries. The question I ask myself is this: ISN’T IT TIME THAT THIS NONSENSE STOPS?

9 Responses to Mistletoe for cancer: Does it improve patients’ quality of life?

  • “One hundred and seventy-three papers were identified; 156 were excluded at initial screening. Seventeen papers were read in full, 14 of which were excluded. ”

    This is perhaps the most depressing aspect, if I am correct in deducing that it means the other 170 papers were, in some sense, bad science or bad statistics. No wonder woo-ologists have no trouble finding “papers” or “studies” to support their drivel if that’s a representative rate. One could say that the concentration of worthwhile papers is almost homeopathic!

  • Several years ago when I was still part of the “academia” I was assistig a student trying to probe this question based on the fact that Sweden at the time was investigating whether Iscador and Helixor (two prominent MT preparations) were to be considered as drugs (in the pure legal sense) or not. The preliminary results (as far as I know the student never actually fiished the project) was just as desolate as those presented in this new assessment – the evidence is of very poor quality indeed… But the work got me thinking – especially after the Medical Products Agency in Sweden a number of years later granted status of “herbal drugs with established use” explicitly stating that effects are expected only when concurrently used together with conventional treatment (in this case cytostatic drugs and/or radiotherapy) – i.e. improvement in quality of life during conventional cancer therapy.
    Hope is a powerful thing, and desperate people tend to have most of it – grabbing for every single strand of hay (don’t know if this have equal standing in English) to find some peace of mind. Can we do better by acknowledging that some patients find relief by taking charge and injecting MT simply by explaining that “herbal drugs with established use” has not been evaluated specifically on merits of efficacy, only that people using this therapy over history has reported success in accordance to the approved indication (in the case of MT “improved quality of life during conventional cancer therapy” as far as approved status goes in Sweden)? Or is this just legal mumbo-jumbo justification of practices (again for the Swedish justification – no person can advise on administration of or prescribe injections unless licensed as physicians or, though only in part, registered nurses) that are not considered conventional and probably useless? Where is the line between patient autonomy and “approved drugs” status?
    At the moment Sweden is at a fulcrum whether homeopathically prepared anthroposophical drugs should gain “article 16.2”-status or not (in Sweden only homeopathic remedies of D4 for oral or topical use can be registered and sold legally). Sadly it does not affect the stature of Iscador or Helixor (or the other remedies registered under “traditional herbal use”-legislation) but will be of immense importance for how licensed practioners will need to approach the legal term of “drug allowed to be sold under Swedish law in accordance to its specific regulations”.

    • @Pharmacist-in-exile
      “Hope is a powerful thing, and desperate people tend to have most of it – grabbing for every single strand of hay” (the English equivalent is ‘clutching at straws’). You have gone directly to the heart of the altmed conundrum: if something makes people feel better, what’s the harm?! The answer has to be: none, so long as those providing the hope don’t grossly misrepresent the straws they offer.
       
      Sadly, the people working for Big Snakeoil seem to lack ethics as well as medical competence. They actively prey on terminally ill patients, and they often claim their particular form of witchcraft can cure all types of disease, which makes them a menace to society. If the mistletoe promoters said no more than that their stuff ‘might make you feel better as you undergo (proper) cancer treatment’ one might regard them in the same category as providers of religious and other forms of psychological support. But they don’t. Many claim the extracts cure cancer. If the stuff has to be given by injection, and its supporters debate which form of mistletoe extract is most effective, when there is zero evidence for any kind of efficacy at all, then it should not be acceptable to any society that genuinely cares about its citizens suffering severe illness.

  • I suspect that no other experimental cancer treatment has been accorded so many studies with so little evidence of efficacy. Apparently, the federal medical authorities of Germany are allowing this to continue with less concern for patients than for the manufacturers.

    • In fairness to the German authorities (and I would not normally be fair to them!) the manufacturers of MT are very small fish and I doubt if they have any political clout. Much more likely would be the influence of Anthro Drs working in these clinics/hospitals.

  • Steiner when he made his pronouncements about mistletoe proclaimed it as a cure; whatever its benefits or otherwise in palliative medicine, its obviously not a cure because if it was we would not be discussing it here.

    Although Anthroposophic doctors have to be real doctors (unlike some other alternative practitioners) my experience is that many Anthro Drs proscribing mistletoe are not oncologists. They put great store in MT and even ask experts which type of mistletoe is best, ie if its from an apple tree or oak etc as different types of cancer are treated with different mistletoe extracts: there is as far as I know, no evidence to back this up – its always anecdotal.

    I think the German economy is in for quite a shock and when this happens it might focus minds on whether it can afford to fund such treatments.

  • Just out of interest… here’s a news article “which ought to operate as a caution to the ignorant and superstitious” about consuming mistletoe ‘The Fatal Effects of Superstition’, from 1813. So its not like this has only just been discovered…

    http://www.foodsofengland.co.uk/Dumb%20Cake%201813.jpg

  • I Just want to share with all of you some information for your consideration:
    http://www.ejcancer.com/article/S0959-8049(13)00550-9/abstract
    http://www.ivaa.info/fileadmin/editor/file/teaser/Cochrane_Comment_Kienle_Kiene_English.pdf
    http://believebig.org/clinical-trial/
    If something does not make sense to your specific point of view it doesn’t necessary means that it is false. Reality is much more complex.

    • @ Sebastian Lopez
      Why don’t you tell us what you find in the above collection of references that is worth discussing?

      The links contain as far as I can tell, the published, peer reviewed report of one unblinded trial with less than promising results that can only be deemed as unreliable, one nitpicking comment on a Cochrane review and one fund-raising advertisement for yet another trial of a commercial mistletoe extract (Please correct me if I am wrong).

      Iscador/Mistletoe extract was invented (not discovered) by the Austrian philosopher, social reformer, architect and esotericist (not scientist/medical expert) Rudolf Steiner, who hypothesised that mistletoe could cure cancer, on the basis of the observation that the plant was a parasite which eventually killed its host, a process which he mistakenly claimed paralleled the progression of cancer. Since then it has been extensively tried and tested with results that have been unanimously evaluated as negative. It can be assumed with a high degree of certainty that this plant and its potential for cancer therapy was already thoroughly investigated by the Cancer Chemotherapy National Service Center of the american National Cancer Institute and also independently by several pharmaceutical firms interested in finding promising compounds for cancer treatment.
      What, in the three references you submit, do you find ithat warrants resuming the discussion of whether this concoction might be beneficial in cancer?

      Add.
      In the above text I borrowed short passages from the Wikipedia pages on Iscador and on Rudolf Steiner. I suggest reading them both for better understanding of why Mistletoe extract is very unlikely to be of benefit in cancer therapy and why scientific resources as well as patient’s funds, time and well being should not be spent on trying it.

      I also suggest reading the Wikipedia page on Paclitaxel to see an example of a plant that was found to be genuinely beneficial in cancer therapy and how plants including mistletoe have been and still are actively screened for medicinal use.

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