For Patients & Caregivers
Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.
What Is It
Aromatherapy uses the scent of concentrated plant oils, known as essential oils, to improve feelings of well-being. It is a popular complementary therapy used to relieve stress and produce other pleasant sensations. Aromatherapy is also practiced in some hospitals to relieve symptoms that are caused by disease or its treatment. Examples of these types of symptoms include nausea, fatigue, anxiety, and sleep problems. Practitioners are often nurses or massage therapists who have had additional training to work with cancer patients and others who require special care.
The most common forms of aromatherapy include the use of diffusers or devices to inhale the scent of essential oils. Several hospitals have established programs and note improvements in patient-reported pain, anxiety, nausea, and other symptoms. For example, sweet marjoram may improve pain, while lavender may help reduce anxiety. Among cancer patients, lavender is commonly used to treat anxiety or sleep problems, while ginger is used to treat nausea. However, a few studies did not find ginger aromatherapy helpful for nasuea or vomiting caused by chemotherapy, although it appears to improve appetite. A study in thyroid cancer patients found a certain aromatherapy combination may increase saliva flow, but this needs to be confirmed in future trials.
Some studies show benefit with aromatherapy as part of therapeutic massage, and in one large trial cancer patients had benefits in anxiety or depression for up to 2 weeks afterwards. Aromatherapy massage was also preferred over cognitive behavior therapy, and had the same benefits on distress in cancer patients. Other studies suggest aroma massage may help hospice patients, particularly with sleep problems. However, large scientific reviews found most studies of aromatherapy massage too small or of poor quality to be reliable. Also, it is not clear whether benefits reported are actually from the use of aroma, massage, or both.
Overall, current research suggests that aromatherapy is popular among patients to address symptoms such as poor sleep, pain, nausea, and anxiety. It is also thought to be a safe and low-cost non-drug approach.
How It Works
By way of the sense of smell, aromatherapy may communicate to parts of the brain that produce certain chemicals like serotonin and dopamine, which may have calming effects or reduce pain. Aromatherapy can also trigger pleasant memories, or patients may have positive expectations that increase benefits.
In addition, some essential oils have certain properties that suggest specific uses. For instance, lavender has shown effects on both anxiety and sleep, but effects on sleep are noticed more at higher dose levels. Ginger is commonly used for nausea, but a few studies in cancer patients did not find ginger aromatherapy helpful for chemotherapy-induced nausea and vomiting, although it may help to stimulate saliva flow and appetite.
In the case of aromatherapy massage, there is also the added environment that may include music, calm surroundings, and a soothing therapist. All of these components may work together to reduce symptoms.
Purported Uses and Benefits
A large hospital study suggests that aromatherapy using lavender or sweet marjoram may help anxiety. Another study in cancer patients found those who were anxious felt more relaxed and less stressed with the use of an aroma inhaler. However, a large trial of aromatherapy during radiation treatments did not show benefits on anxiety. Aromatherapy massage was preferred to cognitive behavior therapy, and had similar benefits on distress in cancer patients.
In a large trial, benefits that lasted for up to 2 weeks after aromatherapy massage were noted among cancer patients.
A large hospital study suggests that ginger aromatherapy may help reduce nausea. In addition, a study in cancer patients found nearly half of nauseous patients experienced relief with fragrance delivered through aroma inhalers. However, aromatherapy did not appear to help nausea caused by chemotherapy in hospitalized children or breast cancer patients, even though it did improve appetite and overall health scores.
In a study that looked at the records of acute care cancer patients, aromatherapy improved sleep in patients. Smaller studies suggest aroma massage may help hospice patients with sleep problems.
Because aromatherapy may help improve sleep, it may also reduce symptoms of fatigue, but studies specifically addressing fatigue have been mixed.
A large hospital study suggests aromatherapy using sweet marjoram may improve pain.
Saliva flow and appetite
In a study of breast cancer patients, ginger aromatherapy improved appetite loss. In thyroid cancer patients, lemon and ginger aromatherapy appeared to increase saliva flow. These results need to be confirmed in larger studies before they can be recommended
Is It Safe
Overall, aromatherapy is thought to be a safe and low-cost non-drug approach to help address symptoms such as poor sleep, pain, nausea, and anxiety. However, some products containing essential oils may have adverse effects.
Skins rashes, sores, blisters, or abnormal skin reaction to sunlight or ultraviolet rays: With exposure to lavender, bergamot, and other types of essential oils. Massage therapists who use aromatherapy often in massage sessions may develop skin rashes or sensitivity to essential oils.
Other reactions upon skin contact: Ylang-ylang, lemongrass, jasmine, sandalwood, and clove oils are known to cause skin sensitivity in some individuals.
Mouth sores: Have occurred with the use of peppermint oil.
Breast enlargement: Repeated application to the skin with products containing lavender and tea tree oils caused abnormal breast growth in pre-teen boys.
Infection and fatalities due to product contamination: In 4 cases of exposure to an imported aromatherapy room spray, 2 of which led to death. Although the product was recalled, it raises awareness of potential risks with products from areas where the bacteria is common.
Who Can Provide this Service
Practitioners of aromatherapy in a hospital setting are usually highly trained professionals, such as nurses or massage therapists who have experience working with patients who may have special needs. They can provide aromatherapy safely to avoid side effects in patients with complicated medical histories.
Where Can I Get Treatment
Many major cancer centers offer integrative medicine therapies that include some forms of aromatherapy treatment, either alone or as a component of aromatherapy massage. Other hospitals are also beginning to incorporate aromatherapy in acute care settings, but this area is still relatively new and may not be used as standard supportive care.
For Healthcare Professionals
Aromatherapy involves the use of aromatic plant oils (essential oils) to stimulate the olfactory sense for improving psychological states and well-being. Traditionally, this practice has been based on holistic principles. It has also become a popular component of complementary therapies and is practiced by specially trained nurses or allied health professionals.
Established aromatherapy programs have been implemented at some hospitals for acute-care interventions in both outpatient and inpatient settings. In a retrospective effectiveness study of nurse-delivered aromatherapy, the use of essential oils resulted in clinical improvements for patient-reported pain, anxiety, and nausea, and other symptoms (1). The majority of treatments were administered via nasal inhalation, with lavender or ginger being used most frequently. Sweet marjoram was found to have the greatest effect for pain, while lavender and sweet marjoram had anxiolytic benefits, and ginger produced the best relief of nausea. However, ginger aromatherapy did not significantly decrease nausea in pediatric cancer patients (26) or chemotherapy-induced nausea and vomiting in breast cancer patients, although it significantly improved measures of global health status, role functioning, and appetite loss (3). Cancer patients using aromastick inhaler devices have also reported reduced anxiety, stress, nausea, and improved sleep (2). In an inpatient acute leukemia unit, a preliminary study of aromatherapy found reduced tiredness, drowsiness, depression, and anxiety, as well as improved appetite and well-being (27). In thyroid cancer patients who underwent radioactive iodine therapy, lemon and ginger essential oil inhalation appeared to increase saliva secretion (4). However, a large double-blind trial of inhalation aromatherapy during radiation treatments did not show benefits on anxiety (5), and lavender aromatherapy as a perioperative adjunct did not improve anxiety, depression, pain, and sleep in women undergoing microvascular breast reconstruction (29).
Aromatherapy is often incorporated as a component of therapeutic massage. In a large multicenter trial, short-term reductions in anxiety and depression were observed among cancer patients who received aromatherapy massage (6). Compared with cognitive behavior therapy, it was shown to have equivalent benefits and was preferred by more cancer patients for emotional distress (7). Aromatherapy massage may also be useful in managing chemotherapy-induced peripheral neuropathy (28). In addition, hospice patients receiving aromatherapy massage experienced reductions in pain and depression (8) and improved sleep (9). At the same time, systematic reviews of aromatherapy massage on symptoms associated with cancer deemed most existing studies too small for reliable findings (10) (11). Combined benefits on pain and anxiety may also be more attributable to massage than the aromatherapy aspect, as in a small study of patients with advanced cervical cancers undergoing brachytherapy (30). More studies are needed to examine these dynamics.
Clinical use of aromatherapy has the potential to enhance patient care as a safe, low-cost nonpharmacologic approach to address symptoms such as poor sleep, pain, nausea, and psychological distress, with high levels of patient preference and compliance (1) (2) (9) (12). In addition, the incorporation of aromatherapy with massage may yield short-term clinical benefits for sleep and distress in acute care populations, although it is unclear how much these effects can be specifically attributed to aromatherapy (6) (7) (9). Larger, more rigorous studies are needed for definitive conclusions (10) (11).
Mechanism of Action
Aromatherapy works through the sense of smell. Because essential oils are so concentrated, they are usually blended with a carrier oil such as grapeseed, coconut, or jojoba oil for dilution (13), especially when used in aromatherapy massage (10).
Proposed mechanisms include access by olfactory signaling pathways to the central nervous system via neurotransmitters such as serotonin and dopamine (14). Essential oil inhalation stimulates olfactory receptor cells, thereby transmitting impulses to the limbic system, which is central to autonomic function and emotions (4). In cancer patients who received radioactive iodine therapy, increased saliva production in those who inhaled lemon and ginger essential oil was attributed to activation of both parasympathetic and sympathetic nervous systems (4).
Anxiolytic and sedative effects with aromatherapy have been shown in animal models (15) (16).
Benefits on improved performance under acute stress conditions have been attributed to aroma-specific pharmacologic and hedonic properties, as well as participant expectations (17).
Some essential oils have been used externally for skin infection due to their antimicrobial activities.
Allergic/hypersensitivity reactions, contact dermatitis with lavender, bergamot, and other essential oils (18) (19) (20). Some essential oils are particularly known as contact sensitizers, including ylang-ylang, lemongrass, jasmine, sandalwood, and clove oils (21).
Perioral and intraoral disorders have occurred with peppermint oil (22).
Allergic contact dermatitis, photodermatitis, and occupational dermatitis: With lavender essential oils (18).
Bullous phototoxic reactions: With exposure to aerosolized bergamot and subsequent UV exposures, for which psoralen-containing compounds may be responsible (20) (23).
Exfoliative dermatitis: With an ayurvedic aromatherapy oil (24).
Prepubertal gynecomastia: With repeated topical application of lavender and tea tree oils (25).
Melioidosis due to product contamination: Cluster of 4 cases, 2 of which led to death, where patients had exposure to an imported commercial aromatherapy room spray contaminated with Burkholderia pseudomallei (31). Although the product was recalled, this highlights risks associated with exposure to imported products from areas where the bacterium is endemic.
Practitioners and Treatments
Many major cancer centers offer integrative medicine therapies that include some forms of aromatherapy treatment, either alone or as a component of aromatherapy massage. While there is no mandatory national certification or licensing requirement for aromatherapy, practitioners are usually nurses, massage therapists, or other allied health professionals experienced in working with cancer patients who may have special needs.