By Jyothirmai Gubili, MS, Melissa Emerzian, MSN, AGPCNP-BC, CBCN®, and Wendy Miner, LMT

Aromatherapy has grown in popularity over the past few decades for improving sleep and mood and for reducing anxiety, but its first use dates back more than 5,000 years. The practice involves using essential (aromatic) oils, derived typically from steam distillation of plants, through application to the skin as a component of therapeutic massage or inhalation with vaporizers, inhalers, or hot water baths.

Current Evidence for Aromatherapy

A retrospective study of nurse-delivered aromatherapy, involving 10,262 patients in an acute care setting, found clinically significant improvements in patient-reported pain, anxiety, and nausea following use of essential oils. Most treatments involved nasal inhalation, and data show sweet marjoram to be most effective for pain, with lavender and sweet marjoram producing anxiolytic benefits and ginger being effective against nausea.

Studies in cancer populations indicate that patients exposed to essential oils via inhaler devices had reduced anxiety, stress, and nausea and improved sleep. And in a randomized, crossover trial involving patients with breast cancer, although ginger aromatherapy was found ineffective for chemotherapy-induced nausea and vomiting, it significantly improved measures of global health status, role functioning, and appetite loss. A comparative study in patients with different types of cancer receiving chemotherapy reported significant reduction in anxiety and improvement in sleep quality following inhalation of lavender oil but not tea tree oil. In a trial of patients with thyroid cancer, inhalation of lemon and ginger essential oil appeared to increase saliva secretion after radioactive iodine therapy. But a large study of inhalation aromatherapy during radiation treatments failed to find any reductions in anxiety.

In a multicenter study of aromatherapy massage in patients with cancer that included 20 essential oils, short-term reductions in anxiety and depression were observed. Other researchers found it to be as effective as cognitive behavior therapy and preferred by more patients for emotional distress. Furthermore, patients receiving hospice care experienced reductions in pain and depression following aromatherapy massage with a blended oil (bergamot, lavender, and frankincense) and improved sleep with lavender oil. But two systematic reviews highlighted the poor methodology of current trials and the need for larger, rigorous studies for definitive conclusions.

Is Aromatherapy Safe?

Aromatherapy is generally considered safe, but allergic/hypersensitivity reactions and contact dermatitis have been reported with lavender, bergamot, and other essential oils; oils derived from ylang-ylang, lemongrass, jasmine, sandalwood, and clove are especially known for their contact-sensitizing (inducing allergic reactions) properties. Perioral and intraoral disorders have been reported with peppermint oil and prepubertal gynecomastia following repeated topical application of lavender and tea tree oils.

Many cancer centers now offer aromatherapy as a pleasant, inexpensive approach for symptom management. It is administered as a standalone treatment or as a component of therapeutic massage. Practitioners include nurses, massage therapists, or other allied health professionals experienced in working with cancer patients. Current evidence indicates benefits of aromatherapy for managing pain, poor sleep, nausea, and psychological distress, with high levels of patient preference and compliance. But well-designed, larger studies are needed to establish recommendations for use.