Nevertheless they have to be interpreted with caution and within their context. The strongest and most consistent results from VAE in clinical studies concern QoL and improved tolerability of conventional MEK inhibitor treatment. QoL questionnaires included mostly well established and

validated QoL instruments and one on psychosomatic self-regulation. The latter is a 16 item QoL instrument that measures competence and autonomy, in terms of the ability to actively adapt to stressful life situations and to restore well-being. [136] This tool has so far been exclusively used in studies focusing on complementary cancer treatments. Improvement was seen especially in relation to self-regulation, fatigue, selleck chemicals sleep, nausea/Selleckchem CHIR99021 vomiting, appetite, diarrhoea, energy, ability to work, enjoyment of life, depression, anxiety, pain, and general physical, emotional, and functional well-being (for more details see Kienle GS, Kiene H: Influence of mistletoe treatment on quality of life in cancer patients. A systematic review of controlled clinical studies. Submitted). Regarding the side effects of conventional oncology treatments, reduced hematopoetic

damage (i.e. leukopenia) and immuno-suppression was reported by some, but not by all studies. Similar, less chemotherapy-related events were observed in some but not in all studies. Validity of this evidence is quite good. 15 RCTs are available, four of them double-blinded (three of them showing a positive result) and one with an active control treatment. 5 RCTs reported following ICH-GCP guidelines and three of them comprised more

than 200 patients each. Questions remain regarding observation or reporting bias, which is of major importance in relation to subjectively assessed outcomes such as QoL and subjective symptoms. Treatment should therefore be blinded; but blinded subcutaneous VAE application can easily be correctly identified by doctors and patients [55, 137], due to its local reactions and mild flu-like symptoms. In the four blinded trials reviewed here, a considerable degree of unblinding was detected by asking patients and physicians HSP90 in one study [55]; and can be presumed in two other of these trials where substantially more VAE-treated patients reported local reactions than control patients [54, 57]. Other RCTs did not blind treatment application, as blinding is unreliable. Therefore questions will remain in “”blinded”" as well as in open trials even though in general cancer or non-cancer trials could not detect relevant improvements of QoL or disease symptoms due to suggestive administration of inert substances [138–140]. Nevertheless, the frequency, magnitude, duration and conditions of QoL or symptomatic improvement in the course of VAE treatment should be clarified in more detail.