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Aromatherapy and Essential Oils (PDQ®)

Health Professional Version
Last Modified: 01/11/2012

Summary of the Evidence for Aromatherapy and Essential Oils

To assist readers in evaluating the results of human studies of complementary and alternative medicine (CAM) treatments for people with cancer, the strength of the evidence (i.e., the levels of evidence) associated with each type of treatment is provided whenever possible. To qualify for a level of evidence analysis, a study must:

Separate levels of evidence scores are assigned to qualifying human studies on the basis of statistical strength of the study design and scientific strength of the treatment outcomes (i.e., endpoints) measured. The resulting two scores are then combined to produce an overall score. A table showing the levels of evidence scores for qualifying human studies cited in this summary is presented below. For an explanation of the scores and additional information about levels of evidence analysis of CAM treatments for people with cancer, refer to Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine 1.

Use of Aromatherapy as a Supportive Care Agent in Cancer and Palliative Care: Table of Clinical Studies
Reference Citations Type of Study/Essential Oil/Mode of Administration No. of Patients Enrolled; Treated; Control Condition Investigated Primary Outcome Secondary Outcome Level of Evidence Score 
[1]Randomized nonblinded triala/lavender (Lavandula angustifolia Miller [synonyms: Lavandula spicata L.; Lavandula vera DC.]) and chamomile blend/massage46; 11; 18Mood, QOL, physical symptomsNo effect on mood, QOL, or physical symptomsNone1ii
[2]Randomized nonblinded triala/lavender/ massage42; 29; 13PainNo effect on painImproved sleep in both groups; reduced depression (in massage group); no effect on QOL1ii
[3]Double-blind randomized control triala/lavender, bergamot (Citrus aurantium L. ssp. bergamia [Risso] Wright & Arn. [Rutaceae]; [synonym: Citrus bergamia Risso]), and cedarwood (Cedrus atlantica [Endl.] Manetti ex Carriere [Pinaceae])/indirect application313Anxiety No effect on anxietyNo effect on depression or fatigue1i
[4]Randomized placebo-controlled double-blind trial/bergamot/ inhalation37; 17; 20Anxiety, nausea, pain in children undergoing stem cell transplantIncreased anxiety and nausea in children 1 hour after stem cell infusion in aromatherapy group; no effect on painParental anxiety declined in both groups1iC
[5]Randomized controlled single-blind trial/sweet orange/inhalation60; 23; 19; 18 (aromatherapy; orange tasting/sniffing; control)Symptom intensity (nausea, retching, cough)Greatest reduction in symptom intensity with orange tasting/sniffingNone1C
[6]Randomized single-blind trial/choice of 20 essential oils/massage39; 20; 19Feasibility; moodImprovements in mood in both groups (aromatherapy massage and cognitive behavioral therapy)Preference for aromatherapy over cognitive behavior therapy1C
[7]Randomized single-blind trial/choice of bitter orange, black pepper, rosemary, majoram, and patchouli/massage45; 15; 15; 15 (aromatherapy massage; plain massage; control)Constipation; QOLImprovement with aromatherapy massageImproved QOL1C
[8]Nonrandomized controlled clinical trial b/lavender, eucalyptus (Eucalyptus globulus Labill. and Eucalyptus radiata Sieber ex DC. [Myrtaceae]), and tea tree/topical application16; 6; 10Infection No effect on incidence of infectionNone2
[9]Nonrandomized controlled clinical trial b/geranium (Pelargonium species), German chamomile (Matricaria recutita L. [synonyms: Matricaria chamomilla L., Chamomilla recutita (L.) Rausch.]), patchouli (Pogostemon cablin [Blanco] Benth. [Lamiaceae] [synonyms: Mentha cablin Blanco, Pogostemon patchouly Letettier]), and turmericphytol/oral application48; 24; 24Gastrointestinal symptomsNo effect on gastrointestinal symptomsNone2
[10]Consecutive case series c/lavender or chamomile/massage18; 8Anxiety, depressionNo reduction in anxiety or depressionReduction in blood pressure, pulse, and respiration3ii
[11]Randomized nonblinded triala/chamomile/massage103; 43; 44Physical and psychological symptoms, QOLReduction in anxiety and in physical and psychological symptoms; improved QOLNone1ii
[12]Randomized nonblinded triala/chamomile/massage52; 26; 25QOL, physical symptoms, anxietyImproved QOL, fewer physical symptoms, reduced anxietyNone1ii
[13]Randomized nonblinded triala/aromatherapy blendd/massage52; 34; 18Anxiety, mobilityDecreased anxiety, pain; improved mobilityNone1ii
[14]Consecutive casea/various oils/massage69General symptomsGeneral improvement in symptoms reported by patients; no statistical analysis completedNone3ii

No. = number; QOL = quality of life.
aPatients with cancer.
bPatients with breast cancer undergoing bone marrow transplantation.
cPatients with malignantbrain tumors.
dLavender (43%), rosewood (29%), rose (7%), and valerian (4%).

References

  1. Wilcock A, Manderson C, Weller R, et al.: Does aromatherapy massage benefit patients with cancer attending a specialist palliative care day centre? Palliat Med 18 (4): 287-90, 2004.  [PUBMED Abstract]

  2. Soden K, Vincent K, Craske S, et al.: A randomized controlled trial of aromatherapy massage in a hospice setting. Palliat Med 18 (2): 87-92, 2004.  [PUBMED Abstract]

  3. Graham PH, Browne L, Cox H, et al.: Inhalation aromatherapy during radiotherapy: results of a placebo-controlled double-blind randomized trial. J Clin Oncol 21 (12): 2372-6, 2003.  [PUBMED Abstract]

  4. Ndao DH, Ladas EJ, Cheng B, et al.: Inhalation aromatherapy in children and adolescents undergoing stem cell infusion: results of a placebo-controlled double-blind trial. Psychooncology : , 2010.  [PUBMED Abstract]

  5. Potter P, Eisenberg S, Cain KC, et al.: Orange interventions for symptoms associated with dimethyl sulfoxide during stem cell reinfusions: a feasibility study. Cancer Nurs 34 (5): 361-8, 2011 Sep-Oct.  [PUBMED Abstract]

  6. Serfaty M, Wilkinson S, Freeman C, et al.: The ToT Study: Helping with Touch or Talk (ToT): a pilot randomised controlled trial to examine the clinical effectiveness of aromatherapy massage versus cognitive behaviour therapy for emotional distress in patients in cancer/palliative care. Psychooncology 21 (5): 563-9, 2012.  [PUBMED Abstract]

  7. Lai TK, Cheung MC, Lo CK, et al.: Effectiveness of aroma massage on advanced cancer patients with constipation: a pilot study. Complement Ther Clin Pract 17 (1): 37-43, 2011.  [PUBMED Abstract]

  8. Gravett P: Aromatherapy treatment for patients with Hickman line infection following high-dose chemotherapy. International Journal of Aromatherapy 11 (1): 18-9, 2001. 

  9. Gravett P: Treatment of gastrointestinal upset following high-dose chemotherapy. International Journal of Aromatherapy 11 (2): 84-6, 2001. 

  10. Hadfield N: The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours. Int J Palliat Nurs 7 (6): 279-85, 2001.  [PUBMED Abstract]

  11. Wilkinson S, Aldridge J, Salmon I, et al.: An evaluation of aromatherapy massage in palliative care. Palliat Med 13 (5): 409-17, 1999.  [PUBMED Abstract]

  12. Wilkinson S: Aromatherapy and massage in palliative care. Int J Palliat Nurs 1 (1): 21-30, 1995. 

  13. Corner J, Cawler N, Hildebrand S: An evaluation of the use of massage and essential oils on the wellbeing of cancer patients. Int J Palliat Nurs 1 (2): 67-73, 1995. 

  14. Evans B: An audit into the effects of aromatherapy massage and the cancer patient in palliative and terminal care. Complement Ther Med 3 (4): 239-41, 1995. 





Glossary Terms

administration (ad-MIH-nih-STRAY-shun)
In medicine, the act of giving a treatment, such as a drug, to a patient. It can also refer to the way it is given, the dose, or how often it is given.
analysis (uh-NA-lih-sis)
A process in which anything complex is separated into simple or less complex parts.
anxiety (ang-ZY-eh-tee)
Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.
aromatherapy massage (uh-ROH-muh-THAYR-uh-pee muh-SAZH)
A type of complementary and alternative medicine that uses rubbing and kneading of the skin with plant oils that give off strong, pleasant aromas (smells) to promote relaxation, a sense of well-being, and healing.
bergamot (BER-guh-mot)
A type of orange tree grown in Italy. The essential oil from the peel of this orange is used in perfume, to get rid of insects, and to flavor tea. Bergamot oil is also used in aromatherapy for depression, anxiety, and poor digestion. The scientific name for the bergamot orange tree is Citrus bergamia.
blood pressure (blud PREH-sher)
The force of circulating blood on the walls of the arteries. Blood pressure is taken using two measurements: systolic (measured when the heart beats, when blood pressure is at its highest) and diastolic (measured between heart beats, when blood pressure is at its lowest). Blood pressure is written with the systolic blood pressure first, followed by the diastolic blood pressure (for example 120/80).
bone marrow transplantation (bone MAYR-oh tranz-plan-TAY-shun)
A procedure to replace bone marrow that has been destroyed by treatment with high doses of anticancer drugs or radiation. Transplantation may be autologous (an individual's own marrow saved before treatment), allogeneic (marrow donated by someone else), or syngeneic (marrow donated by an identical twin).
brain tumor (brayn TOO-mer)
The growth of abnormal cells in the tissues of the brain. Brain tumors can be benign (not cancer) or malignant (cancer).
breast cancer (brest KAN-ser)
Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
cedarwood (SEE-der-WOOD)
A type of evergreen tree with hard fragrant wood that is a member of the cypress family. The oil from the wood is used in soaps, shampoos, bath salts, perfumes, aromatherapy, and to keep insects away. The scientific name is Juniperus virginiana. Also called Eastern red cedar and red cedar.
chamomile (KA-muh-mile)
A family of plants with daisy-like flowers. Two types are German chamomile and Roman or English chamomile. These are used in teas to calm and relax, to improve sleep, and to help with stomach problems. The essential oil (scented liquid taken from plants) of chamomile is used in perfumes, shampoos, lotions, and aromatherapy.
clinical (KLIH-nih-kul)
Having to do with the examination and treatment of patients.
clinical trial (KLIH-nih-kul TRY-ul)
A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.
cognitive behavior therapy (KOG-nih-tiv beh-HAY-vyer THAYR-uh-pee)
A type of psychotherapy that helps patients change their behavior by changing the way they think and feel about certain things. It is used to treat mental, emotional, personality, and behavioral disorders. Also called CBT and cognitive therapy.
complementary and alternative medicine (KOM-pleh-MEN-tuh-ree... all-TER-nuh-tiv MEH-dih-sin)
Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices generally are not considered standard medical approaches. Standard treatments go through a long and careful research process to prove they are safe and effective, but less is known about most types of CAM. CAM may include dietary supplements, megadose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation. Also called CAM.
condition (kun-DIH-shun)
In medicine, a health problem with certain characteristics or symptoms.
consecutive case series (kun-SEH-kyoo-tiv kays SEER-eez)
A clinical study that includes all eligible patients identified by the researchers during the study registration period. The patients are treated in the order in which they are identified. This type of study usually does not have a control group.
constipation (KON-stih-PAY-shun)
A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.
controlled clinical trial (kun-TROLD KLIH-nih-kul TRY-ul)
A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all.
depression (dee-PREH-shun)
A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.
double-blinded (DUH-bul BLINE-ded)
A clinical trial in which the medical staff, the patient, and the people who analyze the results do not know the specific type of treatment the patient receives until after the clinical trial is over.
endpoint (end-point)
In clinical trials, an event or outcome that can be measured objectively to determine whether the intervention being studied is beneficial. The endpoints of a clinical trial are usually included in the study objectives. Some examples of endpoints are survival, improvements in quality of life, relief of symptoms, and disappearance of the tumor.
eucalyptus (YOO-kuh-LIP-tus)
A type of evergreen tree that is a member of the myrtle family. Oil from the leaves is used in very small amounts in mouthwash and in medicines and candy used to treat and soothe sore throats and coughs. It has also been used in some cultures to treat many other medical problems. The scientific name is Eucalyptus globulus.
fatigue (fuh-TEEG)
A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.
gastrointestinal (GAS-troh-in-TES-tih-nul)
Refers to the stomach and intestines. Also called GI.
geranium (jeh-RAY-nee-um)
A type of plant that is native to southern Africa and has white, pink, purple, or red flowers and 3- to 5-lobed leaves. An essential oil that smells like roses is taken from the leaves and used in perfume, in mosquito repellants, and in aromatherapy to treat skin problems and to reduce stress. The scientific name is Pelargonium graveolens. Also called pelargonium.
German chamomile (JER-mun KA-muh-mile)
A plant whose daisy-like flowers are used in tea to calm and relax, improve sleep, and help stomach problems. German chamomile has been studied in the prevention of mucositis (mouth sores) caused by chemotherapy and radiation therapy. It has also been used in some cultures to treat skin conditions, mild infections, and other disorders. The scientific name is Matricaria recutita.
incidence (IN-sih-dents)
The number of new cases of a disease diagnosed each year.
infection (in-FEK-shun)
Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
inhalation (IN-huh-LAY-shun)
In medicine, refers to the act of taking a substance into the body by breathing.
lavender (LA-ven-der)
A plant with aromatic leaves and flowers that is a member of the mint family. Oil from the flowers has been used in some cultures to treat certain medical problems, to keep insects away, and to wash in. It is also used in aromatherapy. Perillyl alcohol, a substance found in lavender, is being studied in cancer prevention and treatment. The scientific name is Lavandula angustifolia. Also called English lavender and true lavender.
levels of evidence (LEH-vulz ... EH-vih-dents)
A ranking system used to describe the strength of the results measured in a clinical trial or research study. The design of the study (such as a case report for an individual patient or a randomized double-blinded controlled clinical trial) and the endpoints measured (such as survival or quality of life) affect the strength of the evidence.
malignant (muh-LIG-nunt)
Cancerous. Malignant cells can invade and destroy nearby tissue and spread to other parts of the body.
massage therapy (muh-SAZH THAYR-uh-pee)
A treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Massage therapy may help people relax, relieve stress and pain, lower blood pressure, and improve circulation. It is being studied in the treatment of cancer symptoms such as lack of energy, pain, swelling, and depression.
nausea (NAW-zee-uh)
A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.
nonblinded (non-BLINE-ded)
Describes a clinical trial or other experiment in which the researchers know what treatments are being given to each study subject or experimental group. If human subjects are involved, they know what treatments they are receiving.
outcome (OWT-kum)
A specific result or effect that can be measured. Examples of outcomes include decreased pain, reduced tumor size, and improvement of disease.
patchouli (puh-CHOO-lee)
A bushy herb that is a member of the mint family. A strong-smelling oil taken from the leaves is used in perfumes, incense, detergents, and hair conditioners. It has been used in some cultures to prevent disease. The scientific name is Pogostemon cablin
peer-reviewed scientific journal (peer-ree-VYOOD SY-en-TIH-fik JER-nul)
A publication that contains original articles that have been written by scientists and evaluated for technical and scientific quality and correctness by other experts in the same field.
phytol (FY-tol)
A chemical substance that comes from plants and is used to make vitamins E and K. Phytol is also found in soaps, beauty care products, and household products.
placebo-controlled (pluh-SEE-boh-kun-TROLD)
Refers to a clinical study in which the control patients receive a placebo.
psychological (SY-koh-LAH-jih-kul)
Having to do with how the mind works and how thoughts and feelings affect behavior.
quality of life (KWAH-lih-tee ... life)
The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.
randomized clinical trial (RAN-duh-mized KLIH-nih-kul TRY-ul)
A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial.
reduction (ree-DUK-shun)
A chemical reaction that takes place when a substance comes into contact with hydrogen or another reducing substance.
response (reh-SPONTS)
In medicine, an improvement related to treatment.
retch (RECH)
The action of the stomach and esophagus to try to vomit (eject some or all of the contents of the stomach). Retching that does not cause vomiting is called dry heaves.
scientist (SY-en-tist)
A person who has studied science, especially one who is active in a particular field of investigation.
stem cell transplant (stem sel TRANZ-plant)
A method of replacing immature blood-forming cells in the bone marrow that have been destroyed by drugs, radiation, or disease. Stem cells are injected into the patient and make healthy blood cells. A stem cell transplant may be autologous (using a patient’s own stem cells that were saved before treatment), allogeneic (using stem cells donated by someone who is not an identical twin), or syngeneic (using stem cells donated by an identical twin).
symptom (SIMP-tum)
An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
tea tree (tee tree)
A tree that is a member of the myrtle family. Oil from the tea tree is used in shampoos and skin care products and to treat skin infections. It has been used in some cultures to treat other skin conditions, including acne, burns, and insect bites. The scientific name is Melaleuca alternifolia.
therapeutic (THAYR-uh-PYOO-tik)
Having to do with treating disease and helping healing take place.
tumor (TOO-mer)
An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
turmeric (TER-mayr-ik)
An East Indian plant that is a member of the ginger family and is used as a spice and food color. The underground stems are used in some cultures to treat certain stomach problems. The substance in turmeric that gives it a yellow color (curcumin) is being studied in the treatment of cancer, Alzheimer disease, cystic fibrosis, and psoriasis. The scientific name is Curcuma longa. Also called Indian saffron and jiang huang.
valerian (vuh-LEER-ee-un)
A plant whose roots are used as a sedative and to treat certain medical conditions. It is being studied as a way to improve sleep in cancer patients undergoing treatment. Also called garden heliotrope, garden valerian, Indian valerian, Mexican valerian, Pacific valerian, Valeriana officinalis, and Valerianae radix.

Table of Links

1http://www.cancer.gov/cancertopics/pdq/levels-evidence-cam/HealthProfessional
2http://www.cancer.gov/cancertopics/pdq/cam/aromatherapy/healthprofessional/Tabl
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