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. 2014;13(2):105-11.
doi: 10.2174/1871528113666140428103332.

Targeting Inflammation in Cancer-Related-Fatigue: A Rationale for Mistletoe Therapy as Supportive Care in Colorectal Cancer Patients

Free PMC article

Targeting Inflammation in Cancer-Related-Fatigue: A Rationale for Mistletoe Therapy as Supportive Care in Colorectal Cancer Patients

Paul R Bock et al. Inflamm Allergy Drug Targets. .
Free PMC article


Background: Cancer-related fatigue (CRF) affects a majority of patients (pts) with symptoms lasting up to several years after finishing therapy. These symptoms lead to decreased health related quality of life. Fatigue during treatment for colorectal cancer is common, but poorly understood and can affect compliance with post-surgical cancer therapy. We examined the fatigue levels during first-line chemo- or radio-chemotherapy protocols, which were supported by a pharmaceutical mistletoe preparation (Iscador(®)Qu) (181patients). We compared the outcome to a parallel control group (143 patients), which did not receive this supportive care treatment.

Methods: The medical records of 324 patients with non-metastasized colorectal cancer (UICC stage I-III), which were obtained from hospitals and resident physicians, were assessed. The documented treatment decision by chemo- or radio-chemotherapy supported by mistletoe interventions was followed for a median treatment period of 8.6 months. During the post-surgical treatment period the patients were diagnosed twice for the presence of fatigue symptoms by structural interviews carried out by physicians.

Results: At the end of the median treatment period, 16/181 patients (8.8%) were diagnosed with CRF in the supportive care group and 86/143 (60.1%) in the chemo- or radio-chemotherapy group without supportive mistletoe medication. Multivariable-adjusted ORs provided evidence for a chance to improve CRF by supportive mistletoe medication compared to chemo- or radio-chemotherapy alone over the time of treatment. The OR = 10.651 (95% CI 5.09-22.28; p < 0.001) declined from the first visit to OR = 0.054 (95 CI 0.02-0.13; p < 0.001) at the end of therapy. Furthermore, 14 confounding factors for risk assessment of CRF were compared by means of forest plots. It turned out that the hospital versus office-based treatment and the co-morbidity/inflammation represent independent but important determinants for fatigue levels.

Conclusion: The clinically used mistletoe medication (Iscador(®)Qu) is the first candidate to be included in a supportive care modus into chemo- or chemo-radiotherapy protocols for colorectal patients to improve CRF without discernable toxicities.


Fig. (1)
Fig. (1)
The columns depict the number of patients diagnosed with symptoms of cancer-related fatigue at the time of diagnosis or surgical intervention (blue), in the midst of the chemo- or radio-chemotherapy protocol with and without ISC®Qu (green) and at the end of the chemo- or radio-chemotherapy with and without ISC®Qu (red). The left three columns present the data of the supportive care group (ISC®Qu), the right three columns the control group (without ISC®Qu).
Fig. (2)
Fig. (2)
(a-c): The statistical results of the adjusted odds ratios and their visualization in forest plots confirm the significant improvement of CRF in ISC®Qu supportively treated patients in comparison with the control group. The forest plots show the importance for the CRF prevalence of some confounders in course of the adjuvant therapy at visits 1, (a), visit 2 (b) & visit 3 (c). Among the potential confounders, comorbidity and the location of treatment (hospital vs private practice) appear important and suggest an independent influence on the outcome of CRF in CRC, who are post-surgically treated with adjuvant chemo- or radio-chemotherapy, supported by ISC®Qu.

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    1. Mitchell SA. Cancer-related fatigue: state of the science. PM&R. 2010;2:364–383. - PubMed
    1. Piper BF, Cella D. Cancer-related fatigue: definitions and clinical subtypes. J. Natl. Compr. Canc. Netw. 2010;8:958–966. - PubMed
    1. Montazeri A. Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008. Health Qual Life Outcomes. 2009;7:102. - PMC - PubMed
    1. Thong MS, Mols E, Wang XS, Lemmens VE, Smilde TJ, van de Poll-Franse LV. Quantifying fatigue in (long term) colorectal cancer survivors: A study from the population-based patient reported outcomes following initial treatment and long term evaluation of survivorship registry. Eur. J. Cancer. 2013;49(8):1957–1966. - PMC - PubMed
    1. Zänker KS, Mihich E, Huber HP, Borresen-Dale AL. Personalized Cancer Care Conference. Meeting Report. J. Pers. Med. 2013;3:70–81. - PMC - PubMed

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