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Frequently asked questions about mistletoe therapy

General questions
How important is mistletoe therapy in the concept of integrative oncology?

Mistletoe therapy is an essential part of a holistic, i.e. integrative, cancer therapy. It is used additionally to conventional oncological treatment.

Complementary treatments like mistletoe therapy can accompany the traditional standard methods, such as surgery, chemo-, radio- and/or (anti-)hormone therapies, with the aim to improve the patient's quality of life.

Since when do mistletoe preparations exist?

Mistletoe preparations have been used in cancer therapy for over 100 years. Today, they are among the most prescribed herbal medicines in cancer medicine. More than half of all tumour patients in German-speaking countries use mistletoe therapy.

Is there any scientific evidence for mistletoe therapy?

Up to today, about 140 clinical studies have been conducted on the use of mistletoe therapy for different types of tumours.

Which active substances do mistletoes contain?

Mistletoes contain various active substances. Some, such as mistletoe lectins and viscotoxins, have been thoroughly studied regarding their effects on cancer therapy.

According to the current state of knowledge, the actual effect unfolds in the mistletoe extract as a whole, as the individual active substances mutually reinforce each other through their interaction.

Why do you produce mistletoe preparations from different host trees?

The host tree supplies the mistletoes with nutrients. This results in a different combination of active substances in the mistletoe, depending on the tree it grows on. Mistletoe extracts from different host trees are used to achieve an optimal effect with the highest tolerability possible, depending on the type of tumour.

What are the differences between the mistletoe preparations of the various producers?

They vary in the pharmaceutical processes used by the manufacturers and consequently in their composition. As a result, you cannot directly compare mistletoe preparations of different producers. When switching to another product, you need to proceed as if for a new setting.

Who can prescribe mistletoe preparations?

In Switzerland, only a medical professional can prescribe mistletoe preparations. In Germany, alternative practitioners are also allowed to prescribe and use mistletoe therapy.

It is important to see mistletoe therapy as a part of an integrative approach to cancer therapy. Therefore, it is always used additionally to conventional oncological treatment and not as a replacement.

Do health insurance companies reimburse the costs of mistletoe therapy?

In Switzerland, basic insurance covers the costs if a medical doctor prescribes the mistletoe preparation.

In Germany, health insurance companies generally reimburse the costs of mistletoe therapy for palliative treatments only. However, there are also companies who cover the costs as a service for their patients for up to one year - it is worth asking.

When should I start mistletoe therapy?

It is possible to start at different points in a treatment plan and at different stages of the disease. Generally speaking: the earlier you begin, the better the effect. In consultation with your treating medical specialist, mistletoe therapy should start as soon as possible after the diagnosis.

How are mistletoe preparations administered?

Mistletoe preparations are injected under the skin (subcutaneous), since in case of oral application in the form of drops, the protein compounds would be digested during passage of the gastrointestinal tract. The injection is similar to the injection of insulin and you can apply it yourself after a thorough instruction by your medical specialist.

Which needle/cannula and which syringe should I use for injection?

We recommend a cannula of 0.4 x 19 mm and a 2 ml syringe.
Please carry out the first injection under the guidance of your attending medical specialist and ask him/her again whenever you may feel insecure.

How often should I inject mistletoe preparations?

Generally, mistletoe preparations are injected two to three times a week. Only the attending medical specialist may adjust the plan if necessary. Particularly during the first months of treatment, an injection rhythm of three times a week (e.g. Monday, Wednesday, Friday) has shown to be beneficial.

What are the characteristics of an effective dosage?

A possible local reaction is a reddening of the skin (also with hardening, itching, swelling or overheating) up to a maximum of 5 cm in diameter around the puncture site, or an increase in body temperature up to 38°C. The local reactions may weaken or even disappear during mistletoe therapy. Furthermore, the general condition can improve, which you may notice in increasing appetite and weight as well as normalising sleep patterns and a sensation of warmth.

For how long is mistletoe therapy applied?

It takes as long as the tumour disease persists. In addition, studies have shown that the therapy should be continued depending on the risk of recurrence (relapse risk). In most cases, this means for about five years starting from the time of diagnosis or after surgery, or even longer (e.g. breast or colon carcinoma). Regularly discuss the treatment with your attending medical specialist.

How do I store mistletoe preparations?

Since herbal medicines can be sensitive to temperature fluctuations, you should store them in the refrigerator at 2°C to 8°C. For transport (from the pharmacy to your home or during holidays), it is possible to deviate from these temperatures for a short time, provided that the total duration of transport is less than 8 days and the temperature is not below 2°C or above 30°C.

Are there any interactions with other therapies or drugs?

So far, no clear interactions are known. Mistletoe therapy is also possible during chemo-, radio- or (anti)-hormone therapy.

In laboratory tests on tumour cells and in practice, no negative effects of mistletoe preparations on the usual chemo- and (anti)-hormone therapies could be found. Also in clinical application, there is no known adverse effect of mistletoe therapy on the efficacy of chemotherapeutics.

Side effects
Are there any side effects?

Side effects are not excluded. However, significant adverse effects have rarely been observed under intended use. If the dosage is too high, so-called excessive local reactions with a diameter of more than 5 cm are possible. In this case, you should stop the treatment and consult your attending medical specialist. Only after the symptoms have subsided, you may continue with a reduced dose (next lower concentration). The same applies to strong general reactions such as an increase in body temperature over 38°C. In this case, you would have to review the further therapy plan with your specialist in charge as well.

How can I differentiate local reactions from side effects?

A slight reddening and possible itching at the injection site as well as a certain increase in body temperature are expected reactions. They indicate the activation of the immune system. Local redness at the subcutaneous injection site up to a maximum of 5 cm in diameter and a temperature increase to 38°C are considered "normal".

However, if the reactions exceed these values or you do not tolerate them, it is considered a side effect. In this case, stop the therapy und consult your attending medical specialist. The dose needs to be reduced once the symptoms have subsided.

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