Mistletoe Extracts (PDQ®)–Patient Version

Overview

Questions and Answers About Mistletoe

  1. What is mistletoe?

    Mistletoe is a semiparasitic plant that grows on trees, such as apple, oak, maple, elm, pine, and birch. It has been used for hundreds of years to treat medical conditions such as epilepsy, hypertension, headaches, menopausal symptoms, infertility, arthritis, and rheumatism.

    Mistletoe is one of the most widely studied complementary and alternative medicine therapies for cancer. In Europe, mistletoe extracts are among the most prescribed therapies for cancer patients.

    Mistletoe products vary, depending on the following factors:

    • The type of host tree on which the mistletoe grows.
    • The species of mistletoe.
    • The type of extract used and if it is made with homeopathic methods.
    • The time of year the plant is picked.
    • The company that makes the product.

    Mistletoe extracts are made in water-based solutions or solutions of water and alcohol. Mistletoe products may be named according to the type of tree on which the plant grows. For example, IscadorM is from apple trees, IscadorP comes from pine trees, IscadorQu is from oak trees, and IscadorU comes from elm trees.

  2. How are mistletoe extracts given?

    Mistletoe extracts are usually given by an injection under the skin (subcutaneous). Less common ways to give mistletoe include by mouth, into a vein (intravenous or IV), into the pleural cavity, or into a tumor.

  3. What laboratory or animal studies have been done using mistletoe extracts?

    In laboratory studies, tumor cells are used to test a substance to find out if it is likely to have any anticancer effects. In animal studies, tests are done to see if a drug, procedure, or treatment is safe and effective in animals. Laboratory and animal studies are done before a substance is tested in people.

    Laboratory and animal studies have tested the effects of mistletoe extracts in laboratory experiments. See the Laboratory/Animal/Preclinical Studies section of the health professional version on Mistletoe Extracts for information on laboratory and animal studies done using mistletoe extracts.

  4. Have any studies of mistletoe extracts been done in people?

    Most clinical trials using mistletoe extracts to treat cancer have been done in Europe. Many studies use mistletoe as adjuvant therapy in patients with cancer. Although these trials have reported mistletoe extracts to be effective, weaknesses have been reported.

    • Size of trial.
    • Lack of patient information.
    • Lack of dose information.
    • Study design.

    Findings from studies with large numbers of patients reported the following:

    In 2002, the National Center for Complementary and Integrative Health (NCCIH) and the National Cancer Institute (NCI) enrolled patients in a phase I clinical trial of a mistletoe extract and gemcitabine in patients with advanced solid tumors. This combination showed low toxicity and no botanical -drug interactions were reported.

    Reviews of combined clinical trials

    Reviews have looked at the effects of mistletoe on quality of life, survival, and symptom relief in different types of cancer:

    • Quality of life was measured in a review that included 26 randomized clinical trials. Of these, 22 trials showed patients had improved quality of life. Chemotherapy-related fatigue, nausea and vomiting, depression, emotional well-being, and concentration improved. All 10 nonrandomized, controlled clinical trials reviewed also reported the same benefits. Some of the studies were well designed, while others had weaknesses.
    • Tumor response, quality of life, and psychological distress were measured in a review of 21 randomized clinical trials in patients with different types of cancer. Mistletoe extracts were used either alone, with chemotherapy, or with radiation therapy. Most of the studies reported benefits for patients, although this review had weaknesses in design and size.
    • Quality of life and survival were measured in a review of 10 randomized clinical trials which used mistletoe extracts in patients with different types of cancer. There was no difference in survival or quality of life measures in patients who received mistletoe compared to those who did not.
  5. Have any side effects or risks been reported from mistletoe?

    Few serious side effects have been reported from the use of mistletoe extracts. Side effects include soreness and inflammation at injection sites, headache, fever, and chills.

    One review reported that treatment was not found to lessen immune system response. High doses of mistletoe damaged the liver in some cases, but damage was correctable. Another review of clinical trials reported adverse effects that included circulatory problems, thrombophlebitis, swelling of lymph nodes, and allergic reactions.

    A few cases of severe allergic reactions, including anaphylactic shock, have been reported.

  6. Is mistletoe approved by the U. S. Food and Drug Administration (FDA) for use as a cancer treatment in the United States?

    The U.S. Food and Drug Administration (FDA) has not approved the use of mistletoe as a treatment for cancer or any other medical condition.

Current Clinical Trials

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Changes To This Summary (04/12/2018)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the use of mistletoe extracts in the treatment of people with cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Integrative, Alternative, and Complementary Therapies Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials are listed in PDQ and can be found online at NCI's website. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

The best way to cite this PDQ summary is:

PDQ® Integrative, Alternative, and Complementary Therapies Editorial Board. PDQ Mistletoe Extracts. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/treatment/cam/patient/mistletoe-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389415]

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 2,000 scientific images.

Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

General CAM Information

Complementary and alternative medicine (CAM)—also called integrative medicine—includes a broad range of healing philosophies, approaches, and therapies. A therapy is generally called complementary when it is used in addition to conventional treatments; it is often called alternative when it is used instead of conventional treatment. (Conventional treatments are those that are widely accepted and practiced by the mainstream medical community.) Depending on how they are used, some therapies can be considered either complementary or alternative. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease.

Unlike conventional treatments for cancer, complementary and alternative therapies are often not covered by insurance companies. Patients should check with their insurance provider to find out about coverage for complementary and alternative therapies.

Cancer patients considering complementary and alternative therapies should discuss this decision with their doctor, nurse, or pharmacist as they would any type of treatment. Some complementary and alternative therapies may affect their standard treatment or may be harmful when used with conventional treatment.

Evaluation of CAM Therapies

It is important that the same scientific methods used to test conventional therapies are used to test CAM therapies. The National Cancer Institute and the National Center for Complementary and Integrative Health (NCCIH) are sponsoring a number of clinical trials (research studies) at medical centers to test CAM therapies for use in cancer.

Conventional approaches to cancer treatment have generally been studied for safety and effectiveness through a scientific process that includes clinical trials with large numbers of patients. Less is known about the safety and effectiveness of complementary and alternative methods. Few CAM therapies have been tested using demanding scientific methods. A small number of CAM therapies that were thought to be purely alternative approaches are now being used in cancer treatment—not as cures, but as complementary therapies that may help patients feel better and recover faster. One example is acupuncture. According to a panel of experts at a National Institutes of Health (NIH) meeting in November 1997, acupuncture has been found to help control nausea and vomiting caused by chemotherapy and pain related to surgery. However, some approaches, such as the use of laetrile, have been studied and found not to work and to possibly cause harm.

The NCI Best Case Series Program which was started in 1991, is one way CAM approaches that are being used in practice are being studied. The program is overseen by the NCI’s Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer alternative cancer therapies submit their patients’ medical records and related materials to OCCAM. OCCAM carefully reviews these materials to see if any seem worth further research.

Questions to Ask Your Health Care Provider About CAM

When considering complementary and alternative therapies, patients should ask their health care provider the following questions:

  • What side effects can be expected?
  • What are the risks related to this therapy?
  • What benefits can be expected from this therapy?
  • Do the known benefits outweigh the risks?
  • Will the therapy affect conventional treatment?
  • Is this therapy part of a clinical trial?
  • If so, who is the sponsor of the trial?
  • Will the therapy be covered by health insurance?

To Learn More About CAM

National Center for Complementary and Integrative Health (NCCIH)

The National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health (NIH) facilitates research and evaluation of complementary and alternative practices, and provides information about a variety of approaches to health professionals and the public.

  • NCCIH Clearinghouse
  • Post Office Box 7923 Gaithersburg, MD 20898–7923
  • Telephone: 1-888-644-6226 (toll free)
  • TTY (for deaf and hard of hearing callers): 1-866-464-3615
  • E-mail: info@nccih.nih.gov
  • Website: https://nccih.nih.gov

CAM on PubMed

NCCIH and the NIH National Library of Medicine (NLM) jointly developed CAM on PubMed, a free and easy-to-use search tool for finding CAM-related journal citations. As a subset of the NLM's PubMed bibliographic database, CAM on PubMed features more than 230,000 references and abstracts for CAM-related articles from scientific journals. This database also provides links to the websites of over 1,800 journals, allowing users to view full-text articles. (A subscription or other fee may be required to access full-text articles.)

Office of Cancer Complementary and Alternative Medicine

The NCI Office of Cancer Complementary and Alternative Medicine (OCCAM) coordinates the activities of the NCI in the area of complementary and alternative medicine (CAM). OCCAM supports CAM cancer research and provides information about cancer-related CAM to health providers and the general public via the NCI website.

National Cancer Institute (NCI) Cancer Information Service

U.S. residents may call the NCI Cancer Information Service toll free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 am to 8:00 pm. A trained Cancer Information Specialist is available to answer your questions.

Food and Drug Administration

The Food and Drug Administration (FDA) regulates drugs and medical devices to ensure that they are safe and effective.

  • Food and Drug Administration
  • 10903 New Hampshire Avenue
  • Silver Spring, MD 20993
  • Telephone: 1-888-463-6332 (toll free)
  • Website: http://www.fda.gov

Federal Trade Commission

The Federal Trade Commission (FTC) enforces consumer protection laws. Publications available from the FTC include:

  • Who Cares: Sources of Information About Health Care Products and Services
  • Fraudulent Health Claims: Don’t Be Fooled
  • Consumer Response Center
  • Federal Trade Commission
  • 600 Pennsylvania Avenue, NW
  • Washington, DC 20580
  • Telephone: 1-877-FTC-HELP (1-877-382-4357) (toll free)
  • TTY (for deaf and hard of hearing callers): 202-326-2502
  • Website: http://www.ftc.gov
  • Updated: April 12, 2018

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