Mistletoe in oncological treatment: a systematic review

Freuding, Maren; Keinki, Christian; Micke, Oliver; Buentzel, Jens; Huebner, Jutta

doi:10.1007/s00432-018-02837-4

Cited by 68 publications

(46 citation statements)

References 47 publications

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“…Fourteen RCTs are reported in the review on overall survival. However, only 12 studies are listed in the review's respective table [21]. In the supplementary material regarding the outcome "overall survival," one study serves with two results: one positive outcome of mistletoe as to nonmetastatic uterine cancer and one negative outcome of mistletoe as to the majority of included gynecological cancers [40].…”

Section: Imprecise Statementsmentioning

confidence: 99%

“…Based on the content of the review [21] and the inclusion of the two missed RCTs [31,32] (see our point of criticism 1, second paragraph), we calculated that 11 of 14 studies (79%) with the outcome "overall survival" revealed a prolongation of survival and three studies (21%) did not show a prolongation of survival, of which two studies were performed with a lectin preparation and not with whole mistletoe extract preparations. In 5 out of 14 studies (36%), the survival was significant (see Figure 1).…”

Section: Imprecise Statementsmentioning

confidence: 99%

“…Freuding et al attribute a multiple testing problem in one publication [50] on the impact of mistletoe on survival in pancreatic cancer [21]. Most probably, this is based on a misunderstanding of the sequential study design.…”

Section: E5mentioning

confidence: 99%

“…erefore, recently, a two-part review on mistletoe treatment in oncology was published [21,22]. However, this two-part review suffers from important methodological flaws and has not been conducted in accordance with the Cochrane Handbook for Systematic Reviews of Intervention and the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) tool [23].…”

Section: Introductionmentioning

confidence: 99%

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Statement to an Insufficient Systematic Review on Viscum album L. Therapy

Matthes

Thronicke

Hofheinz

et al. 2020

Evidence-Based Complementary and Alternative Medicine

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Background. Up to 88% of oncological patients apply complementary therapies and up to 77% apply complementary mistletoe therapy in the context of integrative oncological approaches. An evidence-based consultation of oncological health professionals regarding complementary therapies used in Germany is missing. Therefore, a new S3-Guideline for Complementary Medicine in the Treatment of Oncological Patients is under development and is anticipated to be finalized in November 2020. It will be based on evidence-based publications and systematic reviews on complementary therapies in oncology. A recently published two-part systematic review on mistletoe treatment in oncology has been reevaluated. Methods. The latest published systematic two-part review on mistletoe has been systematically proofread and checked in compliance with the Cochrane Handbook for Systematic Reviews of Intervention and the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) tool. Results. The here discussed two-part review is incomplete, lacks sound accuracy including insufficient assessment of the risk of bias, and contains imprecise statements. In addition, it does not sufficiently comply with the Cochrane Handbook for Systematic Reviews of Intervention and the AMSTAR 2 tool. Conclusion. In view of the approaching release of a new guideline in the field of complementary therapies in oncology, the present statement draws attention to a lack of profound methodology of conductance of a recently released systematic review on mistletoe. In consequence, a comprehensive overview of published mistletoe studies, i.e., a meta-analysis with a sound methodology of conductance, is necessary.

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Section: Imprecise Statementsmentioning

confidence: 99%

Section: Imprecise Statementsmentioning

confidence: 99%

Section: E5mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Statement to an Insufficient Systematic Review on Viscum album L. Therapy

Matthes

Thronicke

Hofheinz

et al. 2020

Evidence-Based Complementary and Alternative Medicine

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“…A number of reviews has been published over the last two decades that address the effects of VAE on QoL in cancer patients [13][14][15][16][17][18][19]. However, these studies are either out of date, don't make use of all published evidence, and/or don't combine the data quantitatively into a pooled effect size.…”

Section: Introductionmentioning

confidence: 99%

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

Loef¹,

Walach

2019

Preprint

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Background: Mistletoe extracts are used as an adjunct therapy for cancer patients, but there is dissent as to whether this therapy has a positive impact on quality of life (QoL). Methods: We conducted a systematic review searching in several databases (Medline, Embase, CENTRAL, CINAHL, PsycInfo, Science Citation Index, clinicaltrials.gov, opengrey.org) by combining terms that cover the fields of 'neoplasm', 'quality of life' and 'mistletoe'. We included prospective controlled trials that compared mistletoe extracts with a control in cancer patients and reported QoL or related dimensions. The quality of the studies was assessed with the Cochrane Risk of Bias tool version 2.We conducted a quantitative meta-analysis. Results: We included 26 publications with 30 data sets. The studies were heterogeneous. The pooled standardized mean difference (random effects model) for global QoL after treatment with mistletoe extracts vs. control was d = 0.61 (95% CI 0.41-0.81; p<0,00001). The effect was stronger for younger patients, with longer treatment, in studies with lower risk of bias, in randomized and blinded studies. Sensitivity analyses support the validity of the finding. 50% of the QoL subdomains (e.g. pain, nausea) show a significant improvement after mistletoe treatment. Most studies have a high risk of bias or at least raise some concern. Conclusion: Mistletoe extracts produce a significant, medium-sized effect on QoL in cancer. Risk of bias in the analyzed studies is likely due to the specific type of treatment, which is difficult to blind; yet this risk is unlikely to affect the outcome.

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