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Mistletoe Therapy

What is Mistletoe Therapy?

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Today, more than two thirds of cancer patients use naturopathic medicine and methods in addition to conventional therapies. The most frequently used herbal medicinal products are mistletoe preparations.

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Mistletoe therapy is possible and advisable in many tumor diseases. We have summarized the most important study results since 2000 for various types of cancer in a generally understandable manner.

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You can start mistletoe therapy at any time – before surgery, afterwards or at a later point in the course of the disease. It can also be combined well with other therapies – this applies to chemotherapy, hormone and antibody therapies as well as targeted therapies or radiation. It does not weaken them, but rather enhances their effect.

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For most types of cancer many clinical studies demonstrate that mistletoe therapy is safe to usewell tolerated and there are only a few contraindications. It improves the quality of life and reduces the side effects of other therapies and – in particular in an integrative therapy concept – it may also contribute to prolonging survival.

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On these pages you will find everything you need to know about the effects of mistletoe therapy on cancer as well as its side effects and contraindicationsreimbursement, what preparations are available, what constituents they contain, how they should be stored and how they differ from each other.

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We have provided for you the most frequently asked questions and answers in a compact format for quick orientation, as well as interesting facts about growth and development along with specific characteristics of the mistletoe plant.

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Mistletoe therapy is not approved for the treatment of leukemia or lymphoma and in general for tumor treatment in children. In these cases, mistletoe therapy is carried out off-label, which means with the consent of the patients or parents and on the responsibility of the treating physician. However, add-on mistletoe for children has been shown to be safe.

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Which Types of Cancer is Mistletoe Therapy Used For?
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For the evaluation of mistletoe therapy in cancer, 157 clinical studies of varying quality are available. 152 of these studies (97 percent) show an advantage for mistletoe therapy. Some of the conclusions from these studies:

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  • it's safe and has only a few side effects

  • it improves quality of life and subjective well-being  

  • it can increase the effectiveness of conventional cancer therapies

  • it can reduce side effects of conventional treatment so that the optimal dose may be used for therapy and the treatment becomes more effective

  • it can alleviate disease- or therapy-related symptoms such as nausea, vomiting, diarrhea and the susceptibility to infections

  • it can relieve tumor-related fatigue-syndrome

  • it can relieve tumor-related pain

  • it stimulates the body’s immune response against the tumor as well as non-specific immune reactions 

  • it can inhibit the growth of cancer cells

  • it can prevent relapses and metastases if necessary

  • it may extend overall survival time

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The extent of the therapeutic effect seems to depend on the duration of mistletoe therapy, the dose, the host tree and the type of application. Biological characteristics of the tumor and the individual readiness of the immune system to respond to mistletoe therapy also play an essential role. 

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On the following pages, we have summarized the current state of clinical research with regard to the different types of cancer. 

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How is Mistletoe Used?

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Mistletoe preparations are offered in the form of ampules for injection and are not available as tablets or capsules for ingestion because they could lose their efficacy in the digestive tract.

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There are different forms of injection:

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Each mistletoe therapy is conducted on an individual basis. The ampules are usually injected under the skin and it is mostly started with a gradual dosage in very low concentration. This will be increased until a local reaction accompanied by reddening of the skin (erythema) is visible.

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The first injection should be performed under the supervision of a doctor to observe the reaction to it. Later, you can administer the dose by yourself at home or have it given to you by your partner or another helping person.

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Other forms of application – into the vein, into the tumor, into body cavities – are currently still off label, which means they have not yet been approved for this type of use by the authorities and should only be carried out by specialized doctors. The intravenous application is gaining importance

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You can start mistletoe therapy as soon as you know you have cancer, even before surgery, as well as before or during chemotherapy, radiotherapy, hormone therapy or antibody therapy. Usually these conventional therapies are better tolerated when mistletoe is applied.

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Are there Side Effects?
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Mistletoe therapy is generally well tolerated. Undesirable effects occur only rarely. The most frequent phenomenon is a reddening of the skin at the injection site. However, this is not an undesirable side effect, but an almost desirable one, because it indicates that the immune system is responding to the mistletoe extract. This is exactly what should be reached.

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This redness or erythema is therefore harmless up to a diameter of 5 cm and will usually subside on its own. It also serves as an orientation for dosing the mistletoe extract.

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If the area reddens more and simultaneously hardens, the dosage of mistletoe extract may be too high. If the body temperature rises above 38 °C on the day of injection or if there occur signs of exhaustion, shivering, a general feeling of illness, headaches or short-term dizziness, the dosage is effective but probably too high. If the dosage is reduced, these symptoms usually disappear again quickly.

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What are the Benefits of Mistletoe Therapy?

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Improves Quality of Life

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Mistletoe therapy helps to awaken and support the powers of recovery – the disease no longer seems insurmountable; life has a future again.

 

Many clinical studies have shown that mistletoe therapy noticeably improves quality of life in the following ways: 

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  • Appetite returns

  • Weight increases – the body gains strength

  • Sleep improves

  • The susceptibility to infections reduces

  • The cold feeling with shivering and freezing, which often occurs with cancer, stops

  • Pain subsides

  • Performance increases

  • The mood brightens and depression subsides

  • Emotional stability grows

  • The fear of the illness, which often dominates thoughts and actions especially in the time following diagnosis, diminishes

  • It becomes easier to distance oneself from the cancer disease and to concentrate instead on life itself

  • You are doing something to treat yourself and are no longer just the object of therapeutic measures

  • You are once again in a better position to make decisions and set priorities in your life. The disease no longer dominates your whole life

  • You come back to yourself and to what constitutes you and your path in life

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Regulates the Immune System

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Essential effects of mistletoe therapy include:

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The immune system is modulated

The number of immune cells increases again (if they were previously reduced)

The growth of cancer cells is reduced (proliferation inhibition)

Cancer cells are stimulated to die (apoptosis)

Genetic material is protected

The side effects of chemotherapy and radiotherapy are less and therefore better tolerated

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Is there Research and Scientific Evidence?
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The short answer is yes. To date, more than 150 studies have been conducted on the clinical use of mistletoe preparations.

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Some of the highest quality research includes the following meta-analyses and systematic reviews. Some of these reviews have already been published before 1996 or relate to mistletoe lectin I-standardized, i.e. phytotherapeutic mistletoe preparations. These and the reviews on immune stimulation, tolerability, dose finding, or other indications than cancer are not analyzed here.

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In the following, the reviews and meta-analyses are discussed sequentially, following the date of their publication. The most recent publications are always on the top of the list: 

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  • Loef and Walach 2020: Quality of life in cancer patients treated with mistletoe: a systematic review and meta-analysis 

  • Ostermann et al. 2020: A systematic review and meta-analysis on the survival of cancer patients treated with a mistletoe preparation (Iscador): an update of findings 

  • Freuding et al. 2019: Mistletoe in oncological treatment: a systematic review; Part 1: Survival and safety 

  • Freuding et al. 2019: Mistletoe in oncological treatment: a systematic review; Part 2: Quality of life and toxicity of cancer treatment

  • Kröz et al. 2016: Is there an indication for mistletoe therapy in the treatment of cancer-related fatigue and insomnia in cancer patients? A review

  • Büssing et al. 2012: Quality of life and related dimensions in cancer patients treated with mistletoe extract (Iscador): a meta-analysis

  • Kienle and Kiene 2010: Influence of Viscum album extracts (European mistletoe) on quality of life in cancer patients: a systematic review of controlled clinical studies

  • Ostermann et al. 2009: Survival of cancer patients treated with mistletoe extract (Iscador): a systematic literature review

  • Kienle et al. 2009: Viscum album extracts in breast and gynaecological cancers: a systematic review of clinical and preclinical research

  • Horneber et al. 2008: Mistletoe therapy in oncology: a Cochrane review

  • Kienle and Kiene 2007: Complementary cancer therapy: a systematic review of prospective clinical trials on anthroposophic mistletoe extracts

  • Lange-Lindberg et al. 2006: Mistletoe therapy as an adjuvant treatment to reduce toxicity of chemotherapy of malignant diseases (DIMDI HTA report)

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Frequently Asked Questions

 

Onset and course of therapy

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When should mistletoe therapy begin?

Mistletoe therapy can be start early, even immediately after diagnosis or before surgery, if this is planned. Since mistletoe therapy activates the immune system and thus promote resistance, the body will be well prepared for the stress that surgery causes to the organism. But a later start is also possible.

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Can mistletoe therapy also be performed during chemo- and/or radiotherapy?
Yes, because mistletoe therapy can reduce the adverse effects of chemo- radio-, hormone or antibody therapy. However, it is essential to ensure that the injection is given outside the radiation field, otherwise the skin can become highly inflamed.

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Does mistletoe interfere with the effects of other drugs?
No, so far there are no known negative interactions with other drugs. The studies available so far show that mistletoe therapy can be well combined with conventional treatment methods like chemo- radio-, hormone or antibody therapy. It can also reduce some of their undesirable effects. 

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How long does the treatment take?
Mistletoe therapy is often a long-term therapy but needs to be accompanied by a health professional. How long the therapy lasts in individual cases depends on how the disease develops and how the organism reacts to the therapy.

 

Do blood levels need to be measured? 
In most cases the blood levels are determined once at the beginning of mistletoe therapy and monitored repeatedly at longer intervals during the course of the treatment. However, such laboratory controls are not absolutely necessary. Each doctor decides which examinations are necessary in the individual case on the basis of the disease situation.

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Does mistletoe therapy influence tumor markers?
The tumor markers change depending on the course of the disease. If the general condition improves or the tumor size reduces as a result of mistletoe therapy, the tumor markers may also decrease again.

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Is mistletoe therapy useful if metastases are already present? 
Yes, because mistletoe therapy can improve quality of life and strengthen the immune system, which may be manifested, for example, in an increase in appetite and weight, normalization of sleep quality and stimulation of the vital spirits revive. 

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Can mistletoe therapy relieve pain?
Mistletoe therapy may reduce the need for analgesics. Pain intensity depends on the tumor growth, your general condition and physical strength. As your condition improves and energy returns, yours pain also decreases.

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Which mistletoe preparation is the appropriate one? 
There is no "right" or "wrong" mistletoe preparation. The most important aspects in the selection of the mistletoe preparation are the type and stage of the tumor, the patient’s individual symptoms and situation of the patient and above all, the question of what is to be achieved with mistletoe therapy. Considering these factors, the doctor needs to find the most suitable preparation. People who are sensitive to drugs may initially be given a rather low-dose mistletoe preparation – some manufacturers offer special preparation series with particularly low initial concentrations for this purpose.

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Side effects

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Is the reddening of the skin an allergy? 
No, redness at the injection site up to 5 cm in diameter is a sign that the immune system reacts to mistletoe therapy. 

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The red spot itches – is that an indication of an allergic reaction? 
No, this is not an indication of an allergy either. The itching can occur when the mild local inflammation caused by the mistletoe extract subsides. 

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Is it dangerous if mistletoe therapy causes fever? 
An increased temperature of up to 38 °C is desired because the organism is stimulated to regulate the body temperature. This ability is often weakened in cancer patients. Many cancer patients who are always shivering feel comfortably warmed up following subcutaneous mistletoe therapy. If temperatures exceed 38° C and persist for more than 3 days, an infectious process or tumor fever should also be considered. If higher fever develops during mistletoe infusion (up to 39.5 °C), this may be therapeutically useful. However, this therapy variant is an off-label application and should therefore always be under medical supervision. If the body temperature remains above 38 °C for more than three days, you should consult your doctor. 

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Can mistletoe stimulate tumor proliferation? 
Neither laboratory experiments nor more than 150 clinical studies have found evidence that mistletoe therapy could stimulate tumor proliferation. 

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Injections

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Should mistletoe preparations always be injected? 
Mistletoe therapy is approved for subcutaneous application. In the form of an oral application, the protein-containing mistletoe extracts would be "digested" in the stomach and made ineffective.  

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Do the injections hurt? 
No, the injection can only be felt as a small prick. It may be as well slightly painful if injection has been given intracutaneously or when a nerve end has been struck by mistake, being however harmless. The needle used for injection is extremely fine and thin. You can look for a place to inject where your body is as insensitive as possible (abdomen, thighs). At the beginning you should be instructed how to inject by a professional, because there are a few tricks and tips on how to inject painlessly.

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Hardenings form at the injection site. Why? 
The hardening is called induration and it is caused by the migration of white blood cells into this region. This induration disappears within a few days, usually the day after the injection. 

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At what time should injection take place? 
If it is important to stimulate the activity of the organism, it is useful to perform the injection during the rising of the body temperature, i.e. in the morning (between 7 and 9 a.m.). If the warming aspect of mistletoe is to be preferred, it is advisable to inject it at the time of maximum body temperature, i.e. in the evening (between 5 and 6 p.m.). In principle a change of both methods is possible.

 

If the next injection is due but the redness has not yet subsided, what can be done? 
Normally you do not inject into the same place again. Nevertheless, you should wait with the next injection until the redness of the previous injection has completely subsided, because otherwise the redness that still exists could intensify to such an extent that a strong and painful inflammatory reaction develops. A redness that does not disappear within two days is often greater than five centimeters, indicating that the dose of mistletoe extract is too

high or that the injection was wrong.

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Source: www.mistletoe-therapy.org

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© 2020 by Dr. Pistoia, PLLC

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