As cancer diagnoses continue to rise globally and increasingly among younger populations (including a significant increase in early-onset colon cancer in under 50’s) there’s a growing recognition that prevention must be a major focus in modern medicine. Integrative medicine focuses on reducing inflammation, a key driver of many chronic diseases, including cancer. Lifestyle habits like fasting, regular exercise, sleep, and stress reduction enhance general health and may lower cancer risk by mitigating tumour growth factors. Strengthening the immune system is also key to this and is where mistletoe therapy can play a role in integrative oncology.

Historical and Modern Uses of Mistletoe

Although in modern times we tend to associate mistletoe with Christmas, mistletoe has been used medicinally for centuries and in the last 100 years particularly for supporting immune function. Mistletoe’s use in cancer care was pioneered by Rudolf Steiner, who saw its potential. In collaboration with Dr Ita Wegman, he developed mistletoe-based treatments, leading to the creation of Iscador, the first standardised mistletoe extract approved for therapeutic use in Europe. Steiner’s model of integrating science with art and spirituality for healing aligns with today’s integrative medicine practices.

Mistletoe has since been researched for its immune-boosting properties, particularly in the activation of natural killer (NK) cells which is critical in cancer defence. Mistletoe is harvested biodynamically, aiming to capture compounds like viscotoxins and lectins that stimulate NK cells. Recent studies also show that probiotics can support these immune cells, suggesting a synergy between mistletoe and other integrative therapies.

Mistletoe and Cancer Immunotherapy

A recent surge in interest in mistletoe therapy reflects patient demand and also ongoing scientific validation. Clinical guidelines from the Society for Integrative Oncology (SIO) highlight mistletoe’s role in improving quality of life during cancer treatment. Studies suggest mistletoe therapy is safe when used alongside conventional treatments, particularly immunotherapies like checkpoint inhibitors, which release the “brakes” on immune cells to enhance tumour recognition and attack.

An important part of our work involves staying up to date with these cutting-edge treatments and ensuring that integrative therapies like mistletoe are safe and compatible with them.

Encouragingly, emerging research shows that mistletoe therapy appears safe when used alongside checkpoint inhibitors, a point underscored by a recent publication from Dr. Nina Fuller Shavel of the Synthesis Clinic. Her comprehensive work looks at the intersection of gut health, exercise, nutrition, and inflammation reduction, and it highlights mistletoe’s compatibility with modern immunotherapies.

Even more exciting are recent findings presented at SIO Europe, a new extension of the Society for Integrative Oncology on the continent. A large cohort study revealed that patients using mistletoe therapy alongside checkpoint inhibitors not only tolerated it well but also showed signs of prolonged survival.

This addresses an important question: Can integrative, multimodal approaches, when thoughtfully combined with conventional treatments, help patients live longer, as well as better? The early data suggest the answer may be yes.

Types of Mistletoe Preparations

Mistletoe is a semi-parasitic plant that grows on trees across the UK and Europe. The European mistletoe (Viscum album) is the species most often used in integrative oncology. But it’s not just the species that matters: the type of tree the mistletoe grows on significantly affects its medicinal properties. This relationship influences the concentration of active compounds such as lectins and viscotoxins, which play a significant role in mistletoe’s immunomodulatory and cytotoxic effects.

Mistletoe harvested from deciduous trees (like oak, apple, or ash) often has a stronger immune-stimulating effect. On the other hand, mistletoe from coniferous trees (such as pine or fir) is gentler and often used in patients needing more delicate support during treatment.

For example:

* Pine-derived mistletoe (Iscador P) is often used for melanoma due to its gentler action and lower viscotoxin levels.

* Apple or oak mistletoe may be selected for other cancer types due to stronger immune stimulation.

Over decades of use and research, various types and preparations of mistletoe have been studied for their unique effects on the immune system and on specific cancer types. This has led to the understanding that mistletoe therapy should be individualised, taking into account the patient’s type of cancer, immune status, and even their subjective experiences during treatment.

In the UK, several mistletoe manufacturers are commonly used, including, Iscador, Helixor, Abnoba viscum. Each company produces mistletoe extracts using different preparation methods, making them not directly comparable, but each has distinct benefits. While we primarily use Iscador at NCIM, we also incorporate other preparations such as Helixor and Abnova Viscum, depending on the patient’s needs. These manufacturers offer a wider range of mistletoe types that can be selected based on the patient’s individual response, cancer type, and treatment goals. The choice of mistletoe is often influenced by how it interacts with the immune system, and what the optimal therapeutic effect might be for the individual.

Administration and Dosing

Mistletoe is most commonly administered subcutaneously, with injections given twice a week, starting with low doses and gradually increasing. The rhythmic pattern of mistletoe administration aligns with the body’s natural rhythms, improving circadian functions and energy levels. Research shows that morning mistletoe injections can help boost energy and enhance sleep quality, optimising therapeutic benefits. Other methods, including intravenous and oral preparations, are also available but less commonly used. We don’t offer intravenous injections at NCIM but we do offer oral preparations where appropriate. This is a herbal preparation still, but anthroposophically prepared in low concentration, so taken by mouth and with water typically daily for a number of days. It can be useful when subcutaneous method isn’t possible, for example, where someone isn’t able to take injections or feels more comfortable taking it orally.

Unlike more immediate therapies, mistletoe works slowly, with effects often visible after weeks or even months. This gradual approach makes it important to monitor progress using a combination of objective and subjective measures:

* Objective measures: Blood tests, such as neutrophil-lymphocyte ratios or tumour markers, can help track immune system changes.

* Assessing body temperature looking for a slight rise in baseline and a more marked rise in temperature on the days of injection.

* Subjective measures: Patient-reported outcomes, including assessments of fatigue, quality of life, and general well-being, provide insights into how the patient is feeling.

Together, these various methods of monitoring give a comprehensive picture of how mistletoe therapy is impacting the patient’s overall health.

The warming effect of mistletoe, similar to rosemary oil, can be particularly beneficial in addressing the cold sensation that many cancer patients experience due to treatment. In anthroposophical medicine, warmth is a central concept, not only physical but also emotional and social. Mistletoe’s warming properties can improve circulation, promote comfort, and encourage positive emotional and social connections, which play a crucial role in healing.

Integration with Other Treatments

Mistletoe therapy integrates well with conventional treatments like chemotherapy and is considered safe to use as an adjuvant therapy. By modulating the immune response and supporting overall well-being, it complements other therapies without interfering with their action. Other holistic approaches, such as lifestyle changes and emotional support would also enhance the effectiveness of mistletoe therapy.

As part of an integrative approach to cancer care, fasting or dietary strategies can complement therapies like mistletoe. These strategies support the body during treatment by reducing inflammation and supporting detoxification processes, without risking nutrient loss during critical treatment periods. However, fasting during chemotherapy, especially when combined with steroids, requires careful planning. The fasting-mimicking diet developed by Dr. Valter Longo is one such approach that helps maintain muscle mass and energy levels during treatment while mimicking the effects of fasting on the body.

This diet is designed to provide nutrients without triggering the body’s natural feeding response, thereby reducing inflammation and supporting the body’s detoxification processes. Importantly, it’s often used separately from chemotherapy sessions, ensuring that patients don’t risk losing muscle mass or nutrients during critical treatment times.

There is other important research within Integrative Oncology. A Viennese study on medical homeopathy by Professor Michael Frass showed that cancer patients randomized to receive homeopathic care had a survival advantage compared to those who did not. When combined with therapies like mistletoe, exercise, nutrition, and mind-body techniques such as meditation, this suggests that a comprehensive, whole-person approach may yield real and very measurable benefits.

Cautions and Considerations

Though generally safe, mistletoe therapy should be used cautiously in patients with autoimmune conditions, as certain preparations may induce inflammatory responses. Side effects are typically mild, such as local injection site reactions or temporary fever and are part of the immune system’s activation. Monitoring these side effects would be undertaken by the NCIM doctor with regular follow ups with the patient and we do encourage patients to contact us with any concerns in between appointments.

Conclusion: An Integrative Approach to Cancer Care

If you’re considering mistletoe therapy as part of your cancer care journey, it’s crucial to work closely with a medical team that integrates both the scientific and holistic aspects of this treatment, ensuring safe and effective use alongside other therapies.

Mistletoe therapy is an example of the power of Integrative Oncology: blending conventional treatments with complementary therapies that enhance immune function and the patients overall well-being. By personalising the treatment to each patient’s unique needs and combining it with lifestyle practices, healthcare providers can harness the full potential of mistletoe in cancer care.

Dr Elizabeth Thompson