INTRODUCTION
Mistletoe treatment is a crucial part of integrative cancer care[1]. It is mainly utilized to promote Quality of Life (QoL), improve the tolerability of chemotherapy, and exert an advantage on tumor control and survival[1]. Mistletoe extracts(MEs) contain various biologically active compounds such as lectins, flavonoids, viscotoxins, oligo- and polysaccharides, and triterpene acids[1][2]. They are cytotoxic, have powerful apoptosis-inducing effects, improve the cytotoxicity of anticancer drugs, incite the immune system, have DNA-stabilizing properties in mononuclear cells, and promote endorphins in vivo[1]. When jabbed into tumor-bearing animals, MEs restrain and reduce tumor growth[3]. MEs usually are administered subcutaneously in clinical practice, beginning with low doses that increase according to tolerability and local skin reactions or the lectin content[1]. Several clinical studies have revealed improvements in the quality of life of cancer patients[1]. A recent randomized controlled trial obtained a highly statistically significant survival advantage for patients with advanced pancreatic cancer[4]. Other studies have been irregular in this regard[1]. Case reports have reported regressions of various tumor types after high-dose local applications of MEs[1].
ME treatment for cancer was primarily developed by medical doctors, mainly within anthroposophic medicine, a healthcare strategy that gives integrative, multimodal, system-based cancer care[1]. Therapies are independently applied, tailored to the patient’s specific medical status and complaints, to their emotional, spiritual, social, and mental needs, and their respective aims[1]. Although global effectiveness studies have evaluated individualized treatment applications, they do not present detailed insights and cover only a small domain[1]. It remains unsolved whether such a particular way of applying brings about more reliable results for patients, what those results are, and what characterizes such an individual treatment[1].
USES AND EFFECTIVENESS
1-MISTLETOE IS LIKELY TO BE INEFFECTIVE FOR:-
(a)Head cancer and neck cancer- Shooting European mistletoe extract within the skin before or after surgery or radiation for head cancer and neck cancers does not promote survival[5]
2-INSUFFICIENT EVIDENCE FOR:-
(a)Bladder cancer. Some early study suggests that administering European mistletoe extract within the bladder for six weeks might decrease bladder cancer recurrence in people who have had bladder cancer surgery[5]. Injecting European mistletoe for several months might slow the progression of bladder cancer[5].
(b)Rectal cancer or colon cancer. Early research suggests that some specific European mistletoe extracts, given by injection solely or with standard therapy, might enhance survival in colon cancer patients[5]. But these results have been challenged[5]. So far, there isn’t sufficient reliable proof to support utilizing European mistletoe for this type of cancer. Adhere to proven treatments[5].
(c)Common cold. Early research suggests that a particular European mistletoe extract, given by injection for 12 weeks, might not treat or restrict the common cold[5].
(d)Inflammation of the liver caused by hepatitis C[5]. Study about the effectiveness of European mistletoe in people with hepatitis C is contradictory[5]. Some research suggests that injecting extract of European mistletoe may assist in fighting the infection that causes hepatitis C and promote the quality of life in some people[5]. Other research says that injecting a different European mistletoe product does not assist in fighting the hepatitis C infection but may improve signs of hepatitis C[5].
(e)leukemia. Early research suggests that mainlining a specific European mistletoe extract might enhance the survival of people with chronic myeloid leukemia by more than two years[5].
(h)Anxiety[5]
(i)Headache[5]
(j) menstrual abnormalities[5]
(k) unwanted effects of radiation therapy and chemotherapy[5]
(l) other conditions[5]
More evidence is required to use mistletoe in such conditions[5].
SIDE EFFECTS and SAFETY ASPECTS OF MEs
Infusions are predominantly performed in hospitals, specialized daybeds, or well-suited office-based practices under the guidance of a physician and experienced staff[1]. Some doctors rarely utilize intravenous applications, which is too risky[1]. An emergency case and medicines to manage potential hypersensitivity should be available[1]. Patients are informed about therapy, safety aspects, adverse effects, etc., and signed consent permission sheets[1].
Doctors stated that hypersensitivity might occur more often under intravenous than subcutaneous treatment[1]. Its symptoms include shivering, dyspnea, partly patchy, and cardiovascular reactions, which are usually self-limited and infrequently need intervention[1]. In addition to dose, this reaction was strictly dependent on the speed of infusion[1]. For preventing such reactions, the drip rate of the infusion has to be slow[1]. The patient must be instructed not to increase the speed independently, or the dose must be decreased and accelerated carefully[1]. The preparation changes, i.e. Helaxoir to Abnoba or vice versa, and primary extreme doses of MT must be limited to patients with no prior mistletoe contact. When the safety aspects were considered, these reactions were seldom observed, and intravenous MT was safe in high doses[1]. When patients proceed to develop pseudo allergic reactions, mistletoe infusion therapy is withdrawn[1].
Additionally reported after-effects included self-limited skin blistering due to high-dose induction, flushes, and resurgence of old injection sites[1]. Fever induction and high-dose administration could be very difficult and tiring[1]. Initial shivering, flu-like symptoms, and acute-phase reaction could occur[1]. Emotional reactions can be induced. But all these reactions are of short duration.
Some doctors considered patients suffering from brain tumors, tumor compression, liver metastases, tumor fever, a poor condition during chemotherapy, etc., as inappropriate for intravenous treatment[1].
DOSAGE
Doses depend upon preparation, the patient’s state, and the therapeutic goal[1]. Treatment with IV administration starts with a low dose to evaluate tolerability[6]. If mistletoe is well-tolerated, the amount is raised slowly to a maximum of 1000mg for IV[6]. Infusions last for 1–4 hours[1] and may be used for a few months to help people during active treatment, and in some cases may be utilized for one or more years if well-tolerated and positive outcomes are seen[6].
CONTRAINDICATION
Pregnant women should not administer mistletoe because it might stimulate the uterus and cause a miscarriage[7].
Also, mistletoe interacts with various drugs, e.g. antihypertensive drugs, and causes blood pressure to go too low, immunosuppressants- mistletoe promotes immune response because it renders immunosuppressants ineffective[7].
So be cautious before administering mistletoe IV therapy along with drugs mentioned above [7]
KEYWORDS:- cancer care, chemotherapy, anticancer drugs, cancer, head cancer, neck cancer,
rectal cancer, colon cancer, leukemia, bladder cancer, radiation therapy.
REFERENCES
[1]Kienle, Gunver S., et al. “Intravenous mistletoe treatment in integrative cancer care: a qualitative study exploring the procedures, concepts, and observations of expert doctors.” Evidence-Based Complementary and Alternative Medicine 2016 (2016).
[2]https://cam-cancer.org/en/mistletoe
[3]Bussing, Arndt. Mistletoe: the genus Viscum. CRC Press, 2000.
[4]Tröger, Wilfried, et al. “Viscum album [L.] extract therapy in patients with locally advanced or metastatic pancreatic cancer: a randomized clinical trial on overall survival.” European Journal of Cancer 49.18 (2013): 3788-3797.
[5]https://www.webmd.com/vitamins/ai/ingredientmono-917/european-mistletoe
[6]https://thechi.ca/wp-content/uploads/2020/05/Mistletoe-Monograph-Patient-Resource-2020.pdf
[7]https://www.rxlist.com/european_mistletoe/supplements.htm
