Patient' and social aspects related to complementary mistletoe therapy in patients with breast cancer: A systematic review commissioned by the German agency for Health Technology Assessment.

Caroline Steigenberger, Petra Schnell-Inderst, Magdalena Flatscher-Thöni, Lisa-Maria Plank, Uwe Siebert

Journal: European journal of oncology nursing : the official journal of European Oncology Nursing Society 2023;65():102338

PMID: 37321128

Full Text on Elsevier Science View on PubMed

Abstract

PURPOSE

To mitigate side effects of conventional cancer care and improve quality of life, many patients with breast cancer in German-speaking countries opt for mistletoe therapy in addition to standard treatment. To understand the value for users, we evaluated the domain "Patient and Social aspects" in a health technology assessment on complementary mistletoe therapy in patients with breast cancer.

METHODS

A systematic review was conducted according to PRISMA guidelines. Fifteen electronic databases and the internet were searched. Qualitative studies were analyzed using qualitative content analysis; quantitative studies were systematically summarized in evidence tables.

RESULTS

Seventeen studies out of 1203 screened publications with 4765 patients and 869 healthcare professionals were included in the review. The median proportion of patients using mistletoe therapy was 26.7% (range: 7.3-46.3%). Predictors for use were younger age and higher educational level. Main reasons for patients' use of mistletoe therapy were to leave nothing untried and to be actively involved in the treatment process. Reasons against use were related to a lack of knowledge or uncertainty regarding effectiveness and safety. Physicians mainly aimed to support the patient's physical condition as main reason for use and a lack of resources and knowledge as main reason against use.

CONCLUSION

Mistletoe therapy was commonly used in the treatment of breast cancer despite a lack of scientific knowledge among patients and physicians. Transparent communication on motivation for use and its potential effect enables realistic expectations. Relatively small samples of mistletoe therapy users limit the representativeness and validity of our results.

Address: Institute for Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria. Electronic address: [email protected].; Institute for Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria.; Institute for Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac Street, Boston, MA, 02114, USA; Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Division of Health Technology Assessment, ONCOTYROL - Center for Personalized Cancer Medicine, Karl-Kapferer-Str. 5, 6020, Innsbruck, Austria.

DOI: 10.1016/j.ejon.2023.102338

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MeSH Terms: Humans, Female, Mistletoe, Plant Extracts, Phytotherapy, Quality of Life, Technology Assessment, Biomedical, Antineoplastic Agents, Phytogenic, Breast Neoplasms, Viscum album