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→Ernst et al 2003: minor, added kienle study 2009
===Meta-analysis===
===Meta-analysis===
==== Büssing et al 2012 ====
====Büssing et al 2012====
[[File:Bussing et al 2012 meta analysis.jpg|none|thumb|214x214px|Meta analysis standard mean difference effects showing an overall treatment effect at SMD = 0.56 (CI: 0.41 to 0.71, ''P'' < .0001), indicating a moderate effect. ]]
[[File:Bussing et al 2012 meta analysis.jpg|none|thumb|214x214px|Meta analysis standard mean difference effects showing an overall treatment effect at SMD = 0.56 (CI: 0.41 to 0.71, ''P'' < .0001), indicating a moderate effect. ]]
[[File:Bussing plausible cause of QOL.jpg|none|thumb|500x500px|Hypothetical diagram explaining the possible mechanisms of ''Viscum album'' extract application on QoL. Büssing, A., Raak, C., & Ostermann, T. (2012). Quality of Life and Related Dimensions in Cancer Patients Treated with Mistletoe Extract (Iscador): A Meta-Analysis. ''Evidence-Based Complementary and Alternative Medicine : ECAM'', ''2012'', 219402. <nowiki>https://doi.org/10.1155/2012/219402</nowiki>]]
[[File:Bussing plausible cause of QOL.jpg|none|thumb|500x500px|Hypothetical diagram explaining the possible mechanisms of ''Viscum album'' extract application on QoL. Büssing, A., Raak, C., & Ostermann, T. (2012). Quality of Life and Related Dimensions in Cancer Patients Treated with Mistletoe Extract (Iscador): A Meta-Analysis. ''Evidence-Based Complementary and Alternative Medicine : ECAM'', ''2012'', 219402. <nowiki>https://doi.org/10.1155/2012/219402</nowiki>]]
quality issues such as lacking description of intention to treat analysis, compliance, and enrolled less than 200 patients, most trials were randomized and all of the results pointed to significant quality of life effects, despite high heterogeneity.
quality issues such as lacking description of intention to treat analysis, compliance, and enrolled less than 200 patients, most trials were randomized and all of the results pointed to significant quality of life effects, despite high heterogeneity.
==== Ernst et al 2003 ====
====Ernst et al 2003====
Ernst et al examined 10 randomized controlled trials. They did not perform statistical analysis because of heterogeneity and concluded an overall lack of benefit of mistletoe. Though they did comment on quality issues with the respective trials, 6 of the 10 did report a benefit.<ref>{{cite journal | vauthors=((Ernst, E.)), ((Schmidt, K.)), ((Steuer-Vogt, M. K.)) | journal=International Journal of Cancer | title=Mistletoe for cancer? A systematic review of randomised clinical trials | volume=107 | issue=2 | pages=262–267 | date=1 November 2003 | doi=10.1002/ijc.11386}}</ref> [[Edzard Ernst]] is a well known integrative medicine skeptic, publishing dozens of review articles on integrative modalities from acupuncture to chiropractic all with negative findings.<ref>{{Citation | title=Edzard Ernst | Skeptical About Skeptics | url=https://skepticalaboutskeptics.org/investigating-skeptics/whos-who-of-media-skeptics/edzard-ernst/ | access-date=17 March 2023}}</ref>
Ernst et al examined 10 randomized controlled trials. They did not perform statistical analysis because of heterogeneity and concluded an overall lack of benefit of mistletoe. Though they did comment on quality issues with the respective trials, 6 of the 10 actually did report a benefit.<ref>{{cite journal | vauthors=((Ernst, E.)), ((Schmidt, K.)), ((Steuer-Vogt, M. K.)) | journal=International Journal of Cancer | title=Mistletoe for cancer? A systematic review of randomised clinical trials | volume=107 | issue=2 | pages=262–267 | date=1 November 2003 | doi=10.1002/ijc.11386}}</ref> [[Edzard Ernst]] is a well known integrative medicine skeptic, publishing dozens of review articles on integrative modalities from acupuncture to chiropractic all with negative findings.<ref>{{Citation | title=Edzard Ernst | Skeptical About Skeptics | url=https://skepticalaboutskeptics.org/investigating-skeptics/whos-who-of-media-skeptics/edzard-ernst/ | access-date=17 March 2023}}</ref>
==== Cochrane Review ====
====Cochrane Review====
A 2008 Cochrane review of 21 trials found mistletoe therapy to be generally safe. There were known issues with methodological quality that limited the strength of findings. The review team found weak evidence for survival benefit and stronger for quality of life improvement. <blockquote>"Of the 16 trials investigating the efficacy of mistletoe extracts for either improving QOL, psychological measures, performance index, symptom scales or the reduction of adverse effects of chemotherapy, 14 showed some evidence of a benefit, but only 2 of them including breast cancer patients during chemotherapy were of higher methodological quality.
A 2008 Cochrane review of 21 trials found mistletoe therapy to be generally safe. There were known issues with methodological quality that limited the strength of findings. The review team found weak evidence for survival benefit and stronger for quality of life improvement. <blockquote>"Of the 16 trials investigating the efficacy of mistletoe extracts for either improving QOL, psychological measures, performance index, symptom scales or the reduction of adverse effects of chemotherapy, 14 showed some evidence of a benefit, but only 2 of them including breast cancer patients during chemotherapy were of higher methodological quality.
The evidence from RCTs to support the view that the application of mistletoe extracts has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak. Nevertheless, there is some evidence that mistletoe extracts may offer benefits on measures of QOL during chemotherapy for breast cancer, but these results need replication."<ref>{{cite journal | vauthors=((Horneber, M.)), ((Ackeren, G.)), ((Linde, K.)), ((Rostock, M.)) | journal=The Cochrane Database of Systematic Reviews | title=Mistletoe therapy in oncology | volume=2008 | issue=2 | pages=CD003297 | date=16 April 2008 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144832/ | doi=10.1002/14651858.CD003297.pub2 | access-date=17 March 2023}}</ref></blockquote>
The evidence from RCTs to support the view that the application of mistletoe extracts has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak. Nevertheless, there is some evidence that mistletoe extracts may offer benefits on measures of QOL during chemotherapy for breast cancer, but these results need replication."<ref>{{cite journal | vauthors=((Horneber, M.)), ((Ackeren, G.)), ((Linde, K.)), ((Rostock, M.)) | journal=The Cochrane Database of Systematic Reviews | title=Mistletoe therapy in oncology | volume=2008 | issue=2 | pages=CD003297 | date=16 April 2008 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144832/ | doi=10.1002/14651858.CD003297.pub2 | access-date=17 March 2023}}</ref></blockquote>
==== Kienle et al 2009 ====
Kienle et al performed a systematic review of preclinical and clincal trials on mistletoe's role in helping treat breast and gynecological cancers in a total of nearly 10,000 patients. In terms of 22 trials assessing survival survival they found "12 reported a statistically significant benefit, the others either a trend or no difference. 3 RCTs and 6 non-RCTs assessed tumour behaviour (remission or time to relapse); 3 reported statistically significant benefit, the others either a trend, no difference or mixed results." Quality of life and tolerability of treatments were also assessed in "15 RCTs and 9 non-RCTs. 21 reported a statistically significant positive result, the others either a trend, no difference, or mixed results." Though trial methodology was a concern, some trials, especially more recent ones, were of good quality. A review of preclinical studies and animal trials found that "VAE and its compounds have strong cytotoxic effects on cancer cells." Kienle et al found that mistletoe therapy was generally well tolerated and safe.<ref>{{cite journal | vauthors=((Kienle, G. S.)), ((Glockmann, A.)), ((Schink, M.)), ((Kiene, H.)) | journal=Journal of Experimental & Clinical Cancer Research | title=Viscum album L. extracts in breast and gynaecological cancers: a systematic review of clinical and preclinical research | volume=28 | issue=1 | pages=79 | date=11 June 2009 | url=https://doi.org/10.1186/1756-9966-28-79 | doi=10.1186/1756-9966-28-79 | access-date=17 March 2023}}</ref>
===Specific Cancer Types===
===Specific Cancer Types===