Supportive Care

Aromatherapy: Using Essential Oils as a Supportive Therapy

Debra Reis

Tisha Jones

chemotherapy, complementary/alternative therapies, quality of life, aromatherapy
CJON 2017, 21(1), 16-19. DOI: 10.1188/17.CJON.16-19

Essential oils can be a great adjunct to cancer care, aiding in the management of side effects, such as insomnia and nausea. Healthcare professionals should be knowledgeable about the quality and safety of essential oils when using them for clinical purposes. Using lesser quality essential oils and not understanding safety guidelines can negatively affect clinical outcomes. This article provides an overview of how nurses can help patients with cancer safely use essential oils as a supportive therapy.

AT A GLANCE

  • Essential oils are a valuable supportive therapy for health and wellness.
  • Oncology nurses should learn about essential oil quality and precautions to help guide patients using essential oils as part of their plans of care.
  • Lavender, peppermint, and orange are common, affordable essential oils that can help support patients with cancer who experience insomnia, nausea, and anxiety.
     

Jump to a section

    Aromatherapy (also referred to as “essential oil therapy”) is defined as “the art and science of utilizing naturally extracted aromatic essences from plants to balance, harmonize and promote the health of body, mind and spirit” (National Association for Holistic Aromatherapy [NAHA], 2016, p. 1). Essential oils are complex mixtures of organic compounds that have a basic carbon hydrogen framework with added “functional groups” (Buckle, 2015; Tisserand & Young, 2014), including alcohols, aldehydes, esters, ethers, ketones, and phenols (Buckle, 2015). Much of essential oil research is focused on chemical constituents and not on the entire oil complex. However, many aromatherapists maintain that essential oils are more than the sum of their parts and that the entire oil should be reviewed in relationship to its healing properties and clinical applications.

    Several cancer centers in the United States are using clinical aromatherapy as a supportive modality (Buckle, 2015; Seely, Weeks, & Young, 2012). Giraud-Roberts (2009) advocated the use of aromatherapy in cancer care to aid a person’s quality of life and limit the side effects of cancer therapies. When using aromatherapy in a clinical setting, safety and oil quality are paramount. The purpose of this article is to provide an overview of how nurses can help patients with cancer safely use essential oils as a supportive therapy.

    How to Use Essential Oils

    Pharmacokinetics is the study of how essential oils are absorbed and excreted. According to Buckle (2015), essential oil components can be absorbed by four routes: inhalation, topical, internal (e.g., gargles, douches, suppositories), and oral (e.g., capsules, dilutions in honey).

    Inhalation is a simple yet effective method to obtain an outcome in seconds. A simple method of inhalation includes putting a drop or two of oil on a tissue and breathing in the aroma. Diffusion is a process that disperses oils into the air, allowing for better absorption of microdroplets through the mucosa. Three ways to diffuse oils into the air include the use of heat, water, and atomizing, which is the preferred method (Stewart, 2005).

    A variety of ways exist to apply essential oils to the body, including using lotions, salves, salt scrubs, bath solubles, and soaps. Essential oil dilution with a carrier oil, such as organic coconut oil or jojoba oil, is the preferred method for application on the skin (Schnaubelt, 2011). Patients should use essential oil internally or orally only under the guidance of a certified aromatherapist.

    Safety Guidelines and Essential Oil Quality

    Before using essential oils, patients must understand safety and quality. General safety guidelines are provided in Figure 1. According to Schnaubelt (1999), when using essential oils for healing purposes, patients should acquire oils through a company that shares the vision of healing versus a company whose primary focus is economic gain. Many factors can affect the quality of oil; therefore, consumers should buy essential oils from companies that use organic farming, monitor farming and distillation processes, conduct independent testing, and adhere to quality standards. Only genuine essential oils should be used for clinical and healing purposes. Most (if not all) essential oils in the general market have synthetic additives or fractions removed (Price & Price, 2012). In addition, the majority of essential oils used for aromatherapy in the United States are fabrications; the oils are not exclusively from a single plant source, which can significantly alter their composition (Schnaubelt, 2011). The four types of essential oils are:

    •  Synthetic or nature-identical oils are produced in a laboratory setting and are often available in health food and novelty stores. They have no therapeutic efficacy and may cause harm.

    •  Extended or altered oils are fragrance-quality oils with a perfume aroma. These oils are comprised of an essential oil base but are enhanced with specific laboratory-created constituents to increase volume or fragrance.

    •  Natural oils (organic) and certified oils meet standard testing guidelines but contain only a few (if any) therapeutic compounds. These oils may be labeled “100% pure” or “natural.”

    •  Therapeutic-quality essential oils are distilled so that all desired therapeutic compounds are retained. Such oils are often referred to as medicinal quality or genuine essential oils (Life Science Publishing, 2011).

    Essential Oil Safety and Cancer

    Some essential oils may reduce or enhance certain drugs’ effectiveness, depending on the amount of oil used, the strength of the oil, and the method of use. Individuals with estrogen-dependentcancers should avoid essential oils with phytoestrogen-like activity, including aniseed (Pimpinella anisum), clary sage (Salvia sclarea), bitter fennel (Foeniculum vulgare var. amara), sweet fennel (Foeniculum vulgare var. dulce), myrtle (Myrtus communis) and star anise (Illicium verum) (Buckle, 2015). An in vitro study on rats indicated that the essential oils peppermint (type unknown) and eucalyptus (Eucalyptus globulus) should not be used topically near an IV catheter site administering 5-fluorouracil because of a potential increase in absorption of medication (Buckle, 2015).

    During cancer treatment, skin changes may occur. Therefore, skin testing an essential oil, whether diluted or not, to observe for redness may be a prudent practice for topical application (Schnaubelt, 2011). Most skin reactions occur immediately, but some delayed reactions may not be observed for as long as 24 hours after application. In addition, essential oils or blends should not be applied to skin areas where topical medications have been applied. Information is not available on the combination of a chemical medication and organic essential oil on the same area of skin, which may cause an unwanted reaction (Buckle, 2015).

    Essential Oils for Supportive Care

    Lavender (Lavandula angustifolia), peppermint (Mentha x piperita), and orange (Citrus sinesis) are common essential oils that can be used as adjuncts to a supportive plan of care for patients with cancer. Lavender has been shown to help provide a calming sensation to promote sleep, peppermint to help decrease nausea and vomiting, and orange to lessen anxiety.

    Lavender

    Lavender, also known as true lavender or English lavender, is made from flowers with a steam-distilled method. The primary constituents of lavender are linalool (monoterpene alcohol) and linalyl acetate (ester). Monoterpene alcohols can have a sedative effect, relieve discomfort, and support immune function. Esters have properties that are antispasmodic, relaxing, and balancing (Higley & Higley, 2012; NAHA, 2015).

    Lavender has been extensively studied as a sleep aid. Patients with cancer often experience insomnia, which may be related to steroid treatment regimens, the inherent stress related to a cancer diagnosis, and psychosocial issues related to family and work. A systematic review of lavender’s effect on sleep (Fismer & Pilkington, 2012) included eight studies of lavender administered by inhalation. Study participants included hospitalized older adults, other hospital patients, college students, healthy individuals, and females. Although most of these studies were small, the findings suggest that lavender oil may have a small to moderate beneficial effect on sleep.

    Precautions

    The labeling of lavender is a safety concern because adulterations of lavender are common and recognizing an adulterated lavender oil from a genuine lavender essential oil can be difficult (Schnaubelt, 1999). Lavandin (Lavandula x intermedia) essential oil is from a hybrid plant and can be labeled lavender in the United States; however, the chemical constituents are different and may cause skin irritation. Lavender is known to be calming; however, too much lavender can have a stimulating effect (Price & Price, 2012). Lavender should be used with caution if a person is on medication for anxiety or depression, as it may enhance the effects of these medications (Buckle, 2015).

    Peppermint

    Peppermint is steam distilled from leaves, stems, and flower buds. The main chemical constituents in peppermint are menthol (phenolic alcohol) and menthone (ketone). Phenolic alcohols enhance the immune system and strengthen the nervous system, and ketones assist the body with cell regeneration and liquefaction of mucous (Higley & Higley, 2012; NAHA, 2015).

    Nausea is reported as the primary distressing symptom in patients undergoing chemotherapy, despite significant improvements in antiemetic medication. An estimated 70%–80% of patients receiving chemotherapy experience nausea and vomiting (Lindley, Bernard, & Fields, 1989). One study (Tayarani-Najaran,Talasaz-Firoozi, Nasiri, Jalali, & Hassanzadeh, 2013) looked at ingesting oils to help with chemotherapy-induced nausea and vomiting, in which both peppermint (Mentha x piperita) and spearmint (Mentha spicata) were given orally by capsule (filled with two drops of oil and sugar) along with a normal antiemetic regimen. The essential oil capsules were administered 30 minutes before chemotherapy initiation, four hours after the first capsule, and four hours later at home. The researchers concluded that the patients who received either peppermint or spearmint capsules had a statistically significant (p < 0.05) reduction of nausea and vomiting in the first 24 hours compared to the placebo group, without any adverse effects. No significant differences existed between the two oils in controlling vomiting, and the reported cost of treatment was significantly lower than the antiemetic (Tayarani-Najaran et al., 2013).

    Precautions

    Caution should be exercised when using peppermint on the skin, as some people have reported skin irritation (Price & Price, 2012; Smith, 2005). Peppermint should not be used by patients who have atrial fibrillation (Tisserand & Balacs, 1995) or on children younger than 30 months (Schnaubelt, 1999; Smith, 2005).

    Orange

    Orange essential oil is expressed from the peel (Price & Price, 2012). The main constituent in orange oil is a monoterpene called d-limonene. Monoterpenes are found in 90% of citrus peel oils and have energizing qualities and immune-supportingeffects (Higley & Higley, 2012; NAHA, 2015).

    Mood disorders, such as anxiety, stress, and depression, are often experienced by patients undergoing cancer therapy. An estimated 24%–59% of patients with cancer experience cancer-related distress, which can be caused by various factors (Chandwani et al., 2012).

    The anxiolytic effect of the sweet orange aroma was studied in 40 healthy men (Goes, Antunes, Alves, & Teixeira-Silva, 2012). To elicit anxiety, the volunteers took the video-monitored Stroop Color and Word Test and inhaled either sweet orange (Citrus sinesis), tea tree (Melaleuca alternifolia)(aromatic control), or distilled water (nonaromatic control) before the test. Those who inhaled sweet orange showed less anxiety as measured by the State-Trait Anxiety Inventory. These results may be beneficial to individuals experiencing anxiety in an oncology setting.

    Precautions

    Many citrus plants are sprayed with pesticides; therefore, patients should know the source of oils and look for organic oils to ensure the best quality. Orange essential oil is phototoxic and should not be used topically on any area of skin exposed to ultraviolet light (e.g., sun, tanning booth).

    Implications for Practice

    Essential oils can be a great supportive therapy for health and wellness. Oncology nurses should be aware that patients may use essential oils as supplements, which may be contraindicated with specific medications or conditions. They also should be knowledgeable about essential oil quality and safety to help guide patients in their plans of care.

    Lavender, peppermint, and orange are well-known essential oils that have been included in many study methodologies. Nurses should understand essential oils when reviewing the literature, because not all studies provide the botanical/Latin name of oils, making it unclear which specific oils are used. In addition, some researchers use synthetic or altered essential oils as part of their methodology. The results of these studies could be questioned because of the additives in the essential oils, and many clinical aromatherapists would be concerned about patients with compromised immune systems inhaling or applying synthetic products. Because of clinical implications, researchers should clearly indicate which essential oils are used and ensure that oils are of therapeutic, organic quality and are from reputable sources.

    Conclusion

    The NAHA is a recognized leader in aromatherapy and promotes essential oil education for the public, and the Alliance of International Aromatherapists promotes the education of aromatherapists and healthcare professionals on the aspects of essential oils. To learn more about essential oil quality, safety, and uses, visit www.naha.org and www.alliance-aromatherapists.org.

    About the Author(s)

    Debra Reis, RN, MSN, NP, is the coordinator for the Healing Care Program at the ProMedica Cancer Institute and Tisha Jones, MSW, is a grant writer for ProMedica in Toledo, OH. Reis can be reached at deb.reis@promedica.org, with copy to CJONEditor@ons.org. The authors take full responsibility for this content and did not receive honoraria or disclose any relevant financial relationships.

    References

    Buckle, J. (2015). Clinical aromatherapy: Essential oils in healthcare (3rd ed.). St. Louis, MO: Elsevier.
    Chandwani, K.D., Ryan, J.L., Peppone, L.J., Janelsins, M.M., Sprod, L.K., Devine, K., . . . Mustian, K.M. (2012). Cancer-related stress and complementary and alternative medicine: A review. Evidence-Based Complementary and Alternative Medicine, 2012, 1–5. doi:10.1155/2012/979213
    Fismer, K.L., & Pilkington, K. (2012). Lavender and sleep: A systematic review of the evidence. European Journal of Integrative Medicine, 4, E436–E447. doi:10.1016/j.eujim.2012.08.001
    Giraud-Roberts, A.M. (2009, February). Essential oils for cancer patients. Paper presented at the 7th Scientific Wholistic Aromatherapy Conference of the Pacific Institute of Aromatherapy, San Francisco, CA.
    Goes, T.C., Antunes, F.D., Alves, P.B., & Teixeira-Silva, F. (2012). Effect of sweet orange aroma on experimental anxiety in humans. Journal of Alternative and Complementary Medicine, 18, 798–804. doi:10.1089/acm.2011.0551
    Higley, C., & Higley, A. (2012). Reference guide for essential oils (13th ed.). Spanish Fork, UT: Abundant Health.
    Life Science Publishing. (2011). Essential oils desk reference (5th ed.). Lehi, UT: Author.
    Lindley, C.M., Bernard, S., & Fields, S.M. (1989). Incidence and duration of chemotherapy-induced nausea and vomiting in the outpatient oncology population. Journal of Clinical Oncology, 7, 1142–1149.
    National Association for Holistic Aromatherapy. (2015). Explore aromatherapy [Pamphlet]. Raleigh, NC: Author.
    National Association for Holistic Aromatherapy. (2016). What is aromatherapy? Retrieved from https://naha.org/explore-aromatherapy/about-aromatherapy/what-is-aromat…
    Pénöel, D., & Pénöel, R.-E. (1998). Natural home health care using essential oils. La Drome, France: Osmobiose Publishing.
    Price, S., & Price, L. (2012). Aromatherapy for health professionals (4th ed.). Toronto, Canada: Churchill Livingstone.
    Schnaubelt, K. (1999). Medical aromatherapy: Healing with essential oils. Berkeley, CA: Frog.
    Schnaubelt, K. (2011). The healing intelligence of essential oils: The science of advanced aromatherapy. Rochester, VT: Healing Arts Press.
    Seely, D.M., Weeks, L.C., & Young, S. (2012). A systematic review of integrative oncology programs. Current Oncology, 19, E436–E461. doi:10.3747/co.19.1182
    Smith, L.L. (2005). Essential oils for physical, emotional, and spiritual health: A program of certification in aromatherapy. Arvada, CO: Healing Touch Spiritual Ministry Program.
    Stewart, D. (2005). The chemistry of essential oils made simple: God's love manifest in molecules. Marble Hill, MO: CARE Publications.
    Tayarani-Najaran, Z., Talasaz-Firoozi, E., Nasiri, R., Jalali, N., & Hassanzadeh, M.K. (2013). Antiemetic activity of volatile oil from Mentha spicata and Mentha x piperita in chemotherapy-induced nausea and vomiting. eCancerMedicalScience, 7, 290. doi:10.3332/ecancer.2013.290
    Tisserand, R., & Balacs, T. (1995). Essential oil safety: A guide for health care professionals. London, UK: Churchill Livingstone.
    Tisserand, R., & Young, R. (2014). Essential oil safety: A guide for health care professionals (2nd ed.). London, UK: Churchill Livingstone.