Written by Helen Seers, Katja Boehm and the CAM-Cancer Consortium.
Updated May 20, 2017

Aromatherapy

Does it work ?

The overall evidence for aromatherapy based on systematic reviews and randomised clinical trials provides limited evidence suggesting that aromatherapy might have positive short-term, effects on quality of life, physical and psychological problems for people with cancer. There were large variations in the type of aromatherapy used, controls and outcomes in the assessed studies. Most studies had methodological limitations.

No published studies have looked directly at aromatherapy as a cancer treatment. Instead, the literature has investigated aromatherapy’s possible effects in supportive and palliative cancer care such as quality of life and psychological/physical problems associated with cancer.

Systematic reviews

Shin et al. (2016) published a Cochrane review of massage with or without aromatherapy for symptom relief (pain, anxiety, symptoms relating to the breast, and quality of life) for people with cancer 9. Six of the included studies capturing data from 561 participants compared aromatherapy massage with no massage.  The quality of the evidence was judged as very low as studies were generally at a high risk of bias. Although there was some indication of benefit in the aromatherapy-massage groups, this benefit is unlikely to translate into clinically relevant benefit. Results included one RCT showing medium-term pain relief (n= 86, mean difference, MD 5.30; 95% CI 1.52 to 9.08), one RCT showing long-term pain relief (n = 86, MD 3.80; 95% CI 0.19 to 7.41); two RCTs reporting positive results for aromatherapy and anxiety (n= 253, combined MD -4.50; 95% CI -7.70 to -1.30), one RCT (n=86, MD -9.80; 95% CI -19.13 to -0.47) helping with physical breast cancer symptoms;  one RCT (n = 30, MD -2.00; 95% CI -3.46 to -0.54) reporting a medium-term quality of life score was lower (better) for the aromatherapy-massage group compared with the no-massage group. 

Two of the included studies (n=117) compared massage with aromatherapy and massage without aromatherapy. Results showed a lack of evidence for the clinical effectiveness of aromatherapy for the relief of pain, anxiety, depression, physical symptom distress or quality of life.  Key outcomes of studies were not reported in detail due the small size of the trials.  Overall, Shin et al. concluded that there was unclear clinical evidence of any benefit in terms of pain and anxiety relief, due to the methodological limitations of the evidence available 9.

Chen et al. (2016) conducted a meta-analysis of RCTs to look at the clinical effectiveness of aromatherapy massage on reducing pain 10. The authors identified three studies meeting their criteria for inclusion in the meta-analysis, only one of these studies was also included in the above Cochrane review by Shin et al. Chen et al.’s meta-analysis pooled data from 278 participants (135 in aromatherapy and 143 participants in control group). Aromatherapy had a nonsignificant effect on reducing pain (standardized mean difference, SMD=0.01; 95% CI −0.23, 0.24) 10

Yim et al. (2009) carried out a systematic review including six randomised and non-randomised controlled clinical trials on aromatherapy massage in patients with depression 11. Three of these studies evaluated the benefit of Swedish massage (two with lavender oil) for depressive symptoms of cancer patients (mainly women with breast cancer). Results showed significant short term-improvement in anxiety and/or depression compared with usual care. According to the authors, this improvement might be explained by the induction of a relaxation response in the autonomic nervous system. Wilkinson et al.’s (2008) earlier reviews on aromatherapy arrived at similar conclusions; however, none of them deal specifically with the topic of cancer 5.

Randomised controlled trials

An additional 13 RCTs not included in the above reviews have been published and are described in Table 1 12-24. (Chang, 200812, Graham, 200313, Lai, 201114, Lua, 201515, Maddocks-Jennings16, Nakayama et al. 201617, Ndao, 201218, Pimenta 201619, Potter, 201120, Serfaty, 201221, Stringer, 200822, Tamaki et al., 201723, Tang, 201424).

Overall, the evidence of the above RCTs seems to confirm the findings of the systematic reviews and  points to a short-term benefit of aromatherapy massage   with improvement in general quality of life, potential improvement of some physical problems (pain, fatigue), psychological difficulties (anxiety, depression, sleep) and salivary gland function. It is difficult to draw overall conclusion of the evidence as the RCTs used different types of aromatherapy (n=7 relate to aromatherapy massage while n=6 relate to aromatherapy inhalation), use different controls and the findings are not consistent across all of the trials described in Table 1. It is also not possible to assess the efficacy of specific essential oils. The quality of the trials up until now has ranged from low to mediocre.

Citation Helen Seers, Katja Boehm, CAM-Cancer Consortium. Aromatherapy [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Aromatherapy. May 20, 2017.

References

  1. Tisserand R, Balacs T. Essential oil safety. Edinburgh: Churchill Livingstone, 1995.
  2. Tisserand R. Essential oils as psychotherapeutic agents. In: Van Toller S, Dodd GH, eds. Perfumery: The Psychology and Biology of Fragrance. New York, NY: Chapman and Hall, 1988, pp 167-80.
  3. Gattefossé RM. Gattefossé's Aromatherapy. Edited by R Tisserand, Translated by L Davies. Saffron Waldon: The CW Daniel Company, 1993.
  4. Boehm K, Büssing A, Ostermann T. Aromatherapy as an adjuvant treatment in cancer care--a descriptive systematic review. Afr J Tradit Complement Altern Med 2012;9:503-18. eCollection 2012. Review.
  5. Wilkinson S, Barnes K, Storey L. Massage for symptom relief in patients with cancer: systematic review. J Adv Nurs 2008;63:430-9.
  6. Hudson R. The value of lavender for the rest and activity in the elderly patient. Complement Ther Med. 1996;4:52–7.
  7. Perry N, Perry E. Aromatherapy in the management of psychiatric disorders: clinical and neuropharmacological perspectives. CNS Drugs 2006;20: 257-80.
  8. Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M. How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr Cancer Ther 2012;11:187-203
  9. Shin ES, Seo KH, Lee SH, Jang JE, Jung YM, Kim MJ, et al. Massage with or without aromatherapy for symptom relief in people with cancer. The Cochrane database of systematic reviews. 2016(6):Cd009873. Epub 06/04.
  10. Chen TH, Tung TH, Chen PS, Wang SH, Chao CM, Hsiung NH, et al. The Clinical Effects of Aromatherapy Massage on Reducing Pain for the Cancer Patients: Meta-Analysis of Randomized Controlled Trials. Evidence-based complementary and alternative medicine : eCAM. 2016;2016:9147974. Epub 02/18.
  11. Yim VW, Ng AK, Tsang HW, Leung AY. A review on the effects of aromatherapy for patients with depressive symptoms. J Altern Complement Med 2009;15:187-95.
  12. Chang SY. Effects of aroma hand massage on pain, state anxiety and depression in hospice patients with terminal cancer. J Korean Acad Nurs 2008;38:493-502.
  13. Graham PH, Browne L, Cox H, et al. Inhalation aromatherapy during radiotherapy: results of a placebo-controlled double-blind randomized trial. J Clin Oncol 2003;21: 2372-6.
  14. Lai TK, Cheung MC, Lo CK, Ng KL, Fung YH, Tong M, Yau CC. Effectiveness of aroma massage on advanced cancer patients with constipation: a pilot study. Complement Ther Clin Pract 2011;17:37-43.
  15. Lua PL, Salihah N, Mazlan N. Effects of inhaled ginger aromatherapy on chemotherapy-induced nausea and vomiting and health-related quality of life in women with breast cancer. Complement Ther Med 2015;23:396-404.
  16. Maddocks-Jennings W, Wilkinson JM, Cavanagh HM, Shillington D, Maddocks-Jennings W, Wilkinson JM, et al. Evaluating the effects of the essential oils Leptospermum scoparium (manuka) and Kunzea ericoides (kanuka) on radiotherapy induced mucositis: a randomized, placebo controlled feasibility study. European Journal of Oncology Nursing 2009 ;13:87-93.
  17. Nakayama M, Okizaki A, Takahashi K. A randomized controlled trial for the effectiveness of aromatherapy in decreasing salivary gland damage following radioactive iodine therapy for differentiated thyroid cancer. Biomed Res Int 2017;2016:9509810.
  18. Ndao DH, Ladas EJ, Cheng B, Sands SA, Snyder KT, Garvin JH, Kelly KM. Inhalation aromatherapy in children and adolescents undergoing stem cell infusion: results of a placebo-controlled double-blind trial. Psychooncology 2012; 21: 247–54.
  19. Pimenta F, Alves M, Pimenta M, Melo S, Almeida A, Leite J, et al. Anxiolytic effect of Citrus aurantium L. on patients with chronic myeloid leukemia. Phytother Res 2016;30:613-7.
  20. Potter P, Eisenberg S, Cain KC, Berry DL. Orange interventions for symptoms associated with dimethyl sulfoxide during stem cell reinfusions: a feasibility study. Cancer Nurs 2011;34:361-8.
  21. Serfaty M, Wilkinson S, Freeman C, Mannix K, King M. 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 2012;21:563-9.
  22. Stringer J, Swindell R, Dennis M, Stringer J, Swindell R, Dennis M. Massage in patients undergoing intensive chemotherapy reduces serum cortisol and prolactin. Psycho-Oncology 2008;17:1024-31.
  23. Tamaki K, Fukuyama AK, Terukina S, Kamada Y, Uehara K, Arakaki M, et al. Randomized trial of aromatherapy versus conventional care for breast cancer patients during perioperative periods. Breast Cancer Res Treat 2017;162:523-31.
  24. Tang WR, Chen WJ, Yu CT, Chang YC, Chen CM, Wang CH, Yang SH. Effects of acupressure on fatigue of lung cancer patients undergoing chemotherapy: an experimental pilot study. Complement Ther Med 2014;22:581-91.
  25. Ljunggren B. Severe phototoxic burn following celery ingestion. Arch Dermatol 1990;126:1334-6.
  26. Anonymous. Final report on the safety assessment of Hypericum perforatum extract and Hypericum perforatum oil. International Journal of Toxicology. 2001;20 Suppl 2:31-9.
  27. Clark SM, Wilkinson SM. Phototoxic contact dermatitis from 5-methoxypsoralen in aromatherapy oil. Contact Dermatitis 1998;38: 289–90.
  28. Hongratanaworakit T, Buchbauer G. Human behavioral and physiological reactions to inhalation of sweet orange oil. Acta Hort 2005;679:75-81.
  29. Henley DV, Lipson N, Korach KS, et al. Prepubertal gynecomastia linked to lavender and tea tree oils. N Engl J Med 2007; 356:479-85.
  30. Ernst E, Pittler MH, Wider B, Boddy K. The Oxford Handbook of Complementary Medicine. Oxford: Oxford University Press, 2008.
  31. Alliance of International Aromatherapists. A brief history of aromatherapists [web document], URL: http://www.alliance-aromatherapists.org/, accessed May 2017.
  32. University of Maryland Medical Center. Lavender  URL: http://www.umm.edu/health/medical/altmed/herb/lavender [online document], accessed 5th May 2017.
  33. Cancer Research UK. Aromatherapy, URL: http://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/complementary-alternative-therapies/individual-therapies/aromatherapy [website], accessed May 2017.