Meta AnalysisID 459
槲寄生提取物治疗癌因性疲乏：系统评价与Meta分析
CRD42020191967
How effective is the supplementary treatment with mistletoe extracts in reducing cancer-related fatigue symptoms in cancer patients, compared to placebo, standard care, or other phytotherapeutic therapies?
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Record Fields
Scalar fields from the final meta_analysis record.
- Meta Analysis Id
- 459
- Evidence Id
- 9017
- Core Evidence Id
- 9017
- Source Meta Analysis Id
- 435
- Herb2 Meta Analysis Id
- HBMA000435
- Crd Id
- CRD42020191967
- Title
- Treatment of cancer-related fatigue with mistletoe extracts: A systematic review and meta-analysis
- Review Question
- How effective is the supplementary treatment with mistletoe extracts in reducing cancer-related fatigue symptoms in cancer patients, compared to placebo, standard care, or other phytotherapeutic therapies?
- Study Type Included
- Included are RCTs and NRS, prospective and retrospective, with at least one control group and one verum-group receiving mistletoe treatment assessing CRF-severity and/or CRF-prevalence via PROMs and/or medical interviews published in peer-reviewed journals or in grey literature. Excluded are studies where the verum-group received a combination of ME with at least one other complementary therapy in addition to the control group treatment.
- Condition Being Studied
- Cancer-related fatigue (CRF) is a persistent sense of tiredness or exhaustion that is not proportional to recent activity and is related to cancer or cancer treatment. CRF-diagnosis is challenging due to the lack of biomarkers and because diagnostic algorithms only start to be implemented. Diagnosis is most commonly performed by patient-reported outcome measures (PROMs) and, in clinical routine, by medical interviews. Prevalence measured by the latter methods ranges from 32 to 99%, depending on cancer stage and status. Many patients associate CRF with a high level of distress, and therefore interrupt their oncologic treatment or their participation to essential and valued life activities. The National Cancer Institute of the USA declared CRF as a high priority research area in 2015 due to the high prevalence and severity of the symptom. Currently, non-pharmacologic therapies for CRF, such as physical exercise, have the highest level of evidence and consensus in reference guidelines. Pharmacologic therapies would nevertheless be a valuable complementary therapeutic option, as non-pharmacologic therapies have a low effect size and/or cannot be applied to all oncologic settings. The present meta-analysis will therefore analyze the pooled effect size of a pharmacologic therapy (subcutaneous injections of mistletoe extracts).
- Participant
- All cancer patients, including all cancer types, age and sex.
- Animal
- Human Disease Modelled
- Intervention
- Mistletoe extracts (MEs) are aqueous extracts from the European mistletoe Viscum album L. and are frequently used in integrative cancer care. The main indication for MEs are symptoms related to cancer or cancer therapies, such as pain and nausea, and has been reviewed recently by Loef et Walach (2020). MEs have also been reported to reduce cancer-related fatigue (CRF) in the most recent ESMO-guidelines for CRF-diagnosis and treatment (2020). The standard mistletoe treatment protocol, applied in most clinical investigations up to date, consists of subcutaneous injections of ME, three times a week. Injected ME-concentrations can be increased within a fixed range set by the manufacturer, and can be adjusted to the patient response. Further adaptation to the patient is possible by choosing from different host trees or manufacturing methods, leading to an individualized treatment regimen. Individualized treatment regimens are frequent in mistletoe therapy. Individualized treatment regimens are usually not assessed in randomized clinical trials (RCTs). To assess these regimens, real world data analysis in the form of non-randomized controlled studies (NRS) is more and more accepted. The inclusion of NRS into this meta-analysis is therefore necessary to evaluate standardized as well as the individualized forms of mistletoe treatments.
- Comparator Control
- Control groups can be, depending on the oncological setting, various. Control groups will include treatments with placebo, best supportive care only, treatment according to guidelines only, or supplementary treatment with a phytotherapeutic compound other than mistletoe.
- Main Outcome
- The main outcome is the measure of the prevalence and severity of cancer-related fatigue symptoms as measured by patient reported outcome measures and recorded by medical interviews. Measures of effect We opt for the standardized mean differences (post vs. pre) and standard deviations per treatment arm. If baseline mean and end point mean and the corresponding variances or categorical data with odds-ratios are presented, we will convert these numbers and calculate standardized mean differences and standard deviations by employing a validated imputation method.
- Outcome Measure
- Additional Outcome
- N.A. Measures of effect N.A.
- Study Method
- Meta-analysis, Systematic review
- Keyword
- Fatigue; Humans; Mistletoe; Neoplasms; Phytotherapy; Plant Extracts
- Contact
- Florian Pelzer [email protected]
- Organisational Affiliation
- Witten/Herdecke University https://www.uni-wh.de/
- Funding Source
- Verein fuer Krebsforschung Gesellschaft fuer klinische Forschung Witten/Herdecke University
- Other Selection Criteria
- Final Publication
- Same Topic Review
- N.A.
- Published Protocol
- Review Type
- Language
- English
- Country
- Germany, Switzerland
- Review Stage
- Review Ongoing
- First Submission Date
- 2020-09-06
- Registration Date
- 2020-10-07
- Anticipated Start Date
- 2020-05-11
- Anticipated Completion Date
- 2021-02-01
- Title Cn
- 槲寄生提取物治疗癌因性疲乏：系统评价与Meta分析
- Title En
- Treatment of cancer-related fatigue with mistletoe extracts: A systematic review and meta-analysis
- Bilingual Status
- complete