Questions and Answers About Aromatherapy

1. What is aromatherapy?

   Aromatherapy is the use of essential oils from plants to support and balance the mind, body, and spirit. It is used by patients with cancer mainly as a form of supportive care that may improve quality of life and reduce stress and anxiety. Aromatherapy may be combined with other complementary treatments like massage therapy and acupuncture, as well as with standard treatments.

   Essential oils (also known as volatile oils) are the basic materials of aromatherapy. They are made from fragrant essences found in many plants. These essences are made in special plant cells, often under the surface of leaves, bark, or peel, using energy from the sun and elements from the air, soil, and water. If the plant material is crushed, the essence and its unique fragrance are released.

   When essences are extracted from plants in natural ways, they become essential oils. They may be distilled with steam and/or water, or mechanically pressed. Oils that are made with chemical processes are not considered true essential oils.

   There are many essential oils used in aromatherapy, including Roman chamomile, geranium, lavender, tea tree, lemon, cedarwood, and bergamot. Each type of essential oil has a different chemical structure that affects how it smells, how it is absorbed, and how it is used by the body. Even varieties of plants within the same species may have chemical structures different from each other because they are grown or harvested in different ways or locations.

   Essential oils are very concentrated. For example, it takes about 220 lbs of lavender flowers to make about 1 pound of essential oil. Essential oils are very volatile, evaporating quickly when they come in contact with air.

2. What is the history of the discovery and use of aromatherapy as a complementary and alternative treatment for cancer?

   Fragrant plants have been used in healing practices for thousands of years across many cultures, including ancient China, India, and Egypt. Ways to extract essential oils from plants were first discovered during the Middle Ages.

   The history of modern aromatherapy began in the early 20th century, when French chemist Rene Gattefosse coined the term "aromatherapy" and studied the effects of essential oils on many kinds of diseases. In the 1980s and 1990s, aromatherapy was rediscovered in Western countries as interest in complementary and alternative medicine (CAM) began to grow.

3. What is the theory behind the claim that aromatherapy is useful in treating cancer?

   Aromatherapy is rarely suggested as a treatment for cancer, but rather as a form of supportive care to manage symptoms of cancer or side effects of cancer treatment. There are different theories about how aromatherapy and essential oils work. A leading theory is that smell receptors in the nose may respond to the smells of essential oils by sending chemical messages along nerve pathways to the brain's limbic system, which affects moods and emotions. Imaging studies in humans help show the effects of smells on the limbic system and its emotional pathways.

4. How is aromatherapy administered?

   Aromatherapy is used in various ways. Examples include:

   • Indirect inhalation (patient breathes in essential oils by using a room diffuser or placing drops nearby).

   • Direct inhalation (patient breathes in essential oils by using an individual inhaler with drops floated on top of hot water) to treat a sinus headache.

   • Aromatherapy massage (massaging essential oils, diluted in a carrier oil, into the skin).

   • Applying essential oils to the skin by combining them with bath salts, lotions, or dressings.

   Aromatherapy is rarely taken by mouth.

   There are some essential oils commonly chosen to treat specific conditions. However, the types of oils used and the ways they are combined may vary, depending on the experience and training of the aromatherapist. This lack of standard methods has led to conflicting research on the effects of aromatherapy.

5. Have any preclinical (laboratory or animal) studies been conducted using aromatherapy?

   Many studies of essential oils have found that they have antibacterial effects when applied to the skin. Some essential oils have antiviral activity against the herpes simplex virus. Others have antifungal activity against certain vaginal and oropharyngeal fungus infections. In addition, studies in rats have shown that different essential oils can be calming or energizing. When rats were exposed to certain fragrances under stressful conditions, their behavior and immune responses were improved.

   One study showed that after essential oils were inhaled, markers of the fragrance compounds were found in the bloodstream, suggesting that aromatherapy affects the body directly like a drug, rather than indirectly through the central nervous system.

6. Have any clinical trials (research studies with people) of aromatherapy been conducted?

   Clinical trials of aromatherapy have mainly studied its use in the treatment of stress, anxiety, and other health-related conditions in seriously ill patients. Several clinical trials of aromatherapy in patients with cancer have been published with mixed results.

   A few early studies have shown that aromatherapy may improve quality of life in patients with cancer. Some patients receiving aromatherapy have reported improvement in symptoms such as nausea or pain, and have lower blood pressure, pulse, and respiratory rates. Studies of aromatherapy massage have had mixed results, with some studies reporting improvement in mood, anxiety, pain, and constipation and other studies reporting no effect.

   A study of inhaled bergamot in children and adolescents receiving stem cell transplants reported an increase in anxiety and nausea and no effect on pain. Parents receiving the aromatherapy and parents receiving the placebo both showed less anxiety after their children’s transplants. In a study of adult patients receiving stem cell transplants, tasting or sniffing sliced oranges was more effective at reducing nausea, retching, and coughing than inhaling an orange essential oil.

   A small study of tea tree oil as a topical treatment to clear antibiotic -resistant MRSA bacteria from the skin of hospital patients found that it was as effective as the standard treatment. Antibacterial essential oils have been studied to lessen odor in necrotic ulcers.

   No studies in scientific or medical literature discuss aromatherapy as a treatment for cancer.

7. Have any side effects or risks been reported from aromatherapy?

   Safety testing on essential oils shows very few bad side effects or risks when they are used as directed. Some essential oils have been approved as ingredients in food and are classified as GRAS (generally recognized as safe) by the U.S. Food and Drug Administration, within specific limits. Eating large amounts of essential oils is not recommended.

   Allergic reactions and skin irritation may occur in aromatherapists or in patients, especially when essential oils are in contact with the skin for long periods of time. Sun sensitivity may develop when citrus or other oils are applied to the skin before sun exposure.

   Lavender and tea tree oils have been found to have some hormone -like effects. They have effects similar to estrogen (female sex hormone) and also block or decrease the effect of androgens (male sex hormones). Applying lavender and tea tree oils to the skin over a long period of time has been linked in one study to breast enlargement in boys who have not yet reached puberty. It is recommended that patients with tumors that need estrogen to grow avoid using lavender and tea tree oils.

8. Is aromatherapy approved by the U.S. Food and Drug Administration (FDA) for use as a cancer treatment in the United States?

   Aromatherapy products do not need approval by the Food and Drug Administration because no specific claims are made for the treatment of cancer or other diseases.

   Aromatherapy is not regulated by state law, and there is no licensing required to practice aromatherapy in the United States. Professionals often combine aromatherapy training with another field in which they are licensed, for example, massage therapy, registered nursing, acupuncture, or naturopathy. Some aromatherapy courses for healthcare providers offer medical credit hours and include conducting research.

   The National Association for Holistic Aromatherapy (www.naha.org) and the Alliance of International Aromatherapists (www.alliance-aromatherapists.org) are two organizations that have national educational standards for aromatherapists. The National Association for Holistic Aromatherapy (NAHA) plans to have a standard aromatherapy certification in the United States. There are many schools that offer certificate programs approved by NAHA. A list of these schools can be found at http://www.naha.org/schools_level_one_two.htm. National exams ⁹ in aromatherapy are held twice a year.

   The Canadian Federation of Aromatherapists (www.cfacanada.com) certifies aromatherapists in Canada. See the International Federation of Aromatherapists Web site (www.ifaroma.org/) for a list of international aromatherapy programs.

Current Clinical Trials

Check NCI’s list of cancer clinical trials for cancer CAM clinical trials on aromatherapy and essential oils ¹⁰ that are actively enrolling patients.

General information about clinical trials is available from the NCI Web site ¹¹.

Changes to This Summary (10/19/2011)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

General CAM Information

Complementary and alternative medicine (CAM)—also referred to as integrative medicine—includes a broad range of healing philosophies, approaches, and therapies. A therapy is generally called complementary when it is used in addition to conventional treatments; it is often called alternative when it is used instead of conventional treatment. (Conventional treatments are those that are widely accepted and practiced by the mainstream medical community.) Depending on how they are used, some therapies can be considered either complementary or alternative. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease.

Unlike conventional treatments for cancer, complementary and alternative therapies are often not covered by insurance companies. Patients should check with their insurance provider to find out about coverage for complementary and alternative therapies.

Cancer patients considering complementary and alternative therapies should discuss this decision with their doctor, nurse, or pharmacist as they would any therapeutic approach, because some complementary and alternative therapies may interfere with their standard treatment or may be harmful when used with conventional treatment.

Evaluation of CAM Approaches

It is important that the same rigorous scientific evaluation used to assess conventional approaches be used to evaluate CAM therapies. The National Cancer Institute (NCI) and the National Center for Complementary and Alternative Medicine (NCCAM) are sponsoring a number of clinical trials (research studies) at medical centers to evaluate CAM therapies for cancer.

Conventional approaches to cancer treatment have generally been studied for safety and effectiveness through a rigorous scientific process that includes clinical trials with large numbers of patients. Less is known about the safety and effectiveness of complementary and alternative methods. Few CAM therapies have undergone rigorous evaluation. A small number of CAM therapies originally considered to be purely alternative approaches are finding a place in cancer treatment—not as cures, but as complementary therapies that may help patients feel better and recover faster. One example is acupuncture. According to a panel of experts at a National Institutes of Health (NIH) Consensus Conference in November 1997, acupuncture has been found to be effective in the management of chemotherapy-associated nausea and vomiting and in controlling pain associated with surgery. In contrast, some approaches, such as the use of laetrile, have been studied and found ineffective or potentially harmful.

The NCI Best Case Series Program ¹², which was started in 1991, is one way CAM approaches that are being used in practice are being investigated. The program is overseen by the NCI’s Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer alternative cancer therapies submit their patients’ medical records and related materials to OCCAM. OCCAM conducts a critical review of the materials and develops follow-up research strategies for approaches deemed to warrant NCI-initiated research.

Questions to Ask Your Health Care Provider About CAM

When considering complementary and alternative therapies, patients should ask their health care provider the following questions:

• What side effects can be expected?
• What are the risks associated with this therapy?
• Do the known benefits outweigh the risks?
• What benefits can be expected from this therapy?
• Will the therapy interfere with conventional treatment?
• Is this therapy part of a clinical trial?
• If so, who is sponsoring the trial?
• Will the therapy be covered by health insurance?

To Learn More About CAM

National Center for Complementary and Alternative Medicine (NCCAM)

The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) facilitates research and evaluation of complementary and alternative practices, and provides information about a variety of approaches to health professionals and the public.

NCCAM Clearinghouse

Post Office Box 7923 Gaithersburg, MD 20898–7923

Telephone: 1–888–644–6226 (toll free) 301–519–3153 (for International callers)

TTY (for deaf and hard of hearing callers): 1–866–464–3615

Fax: 1–866–464–3616

E-mail: info@nccam.nih.gov

Web site: http://nccam.nih.gov

CAM on PubMed

NCCAM and the NIH National Library of Medicine (NLM) jointly developed CAM on PubMed, a free and easy-to-use search tool for finding CAM-related journal citations. As a subset of the NLM's PubMed bibliographic database, CAM on PubMed features more than 230,000 references and abstracts for CAM-related articles from scientific journals. This database also provides links to the Web sites of over 1,800 journals, allowing users to view full-text articles. (A subscription or other fee may be required to access full-text articles.) CAM on PubMed is available through the NCCAM Web site ¹³. It can also be accessed through NLM PubMed ¹⁴ bibliographic database by selecting the "Limits" tab and choosing "Complementary Medicine" as a subset.

Office of Cancer Complementary and Alternative Medicine

The NCI Office of Cancer Complementary and Alternative Medicine (OCCAM) coordinates the activities of the NCI in the area of complementary and alternative medicine (CAM). OCCAM supports CAM cancer research and provides information about cancer-related CAM to health providers and the general public via the NCI Web site ¹⁵.

National Cancer Institute (NCI) Cancer Information Service

U.S. residents may call the NCI Cancer Information Service toll free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 am to 8:00 pm. A trained Cancer Information Specialist is available to answer your questions.

Food and Drug Administration

The Food and Drug Administration (FDA) regulates drugs and medical devices to ensure that they are safe and effective.

Food and Drug Administration

5600 Fishers Lane

Rockville, MD 20857

Telephone: 1–888–463–6332 (toll free)

Web site: http://www.fda.gov/

Federal Trade Commission

The Federal Trade Commission (FTC) enforces consumer protection laws. Publications available from the FTC include:

• Who Cares: Sources of Information About Health Care Products and Services
• Fraudulent Health Claims: Don’t Be Fooled

Consumer Response Center

Federal Trade Commission

CRC-240

Washington, DC 20580

Telephone: 1-877-FTC-HELP (1-877-382-4357) (toll free)

TTY (for deaf and hearing impaired callers): 202-326-2502

Web site: http://www.ftc.gov/