Halm, M.A., Baker, C., & Harshe, V. (2014). Effect of an essential oil mixture on skin reactions in women undergoing radiotherapy for breast cancer: A pilot study. Journal of Holistic Nursing, 32, 290–303. 

To compare the effects of two topical skin preparations (an essential oil mixture versus standard care using RadiaPlexRx) on the skin of patients with breast cancer during radiation therapy 

Patients were randomly assigned to a control group applying RadiaPlexRx (hyaluronic acid and mannan polysaccharides) or an experimental group using a mixture of four essential oils (frankincense, lavender, geranium, and helichrysum) in a base of jojoba, aloe vera, tamanu, and evening primrose oils. All patients applied their ointment three times daily during treatment until one month after treatment. An RN who was blinded to the participant assignment performed a baseline skin check and weekly skin assessments during radiation treatment at week one through week six, and at the patient’s four-week follow-up visit. Patients completed a skin diary, quality of life index, visual analog scale (VAS) to rate pain, and a patient satisfaction questionnaire at several points during and after treatment.

• N = 24  
• AGE = 18 years or older 
• FEMALES (%): 100
• KEY DISEASE CHARACTERISTICS: Breast cancer diagnosis, status post lumpectomy, receiving radiation therapy for breast cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Patients had to be able to read and speak English, could not have an allergy or sensitivity to the oils in the mixture above, and could not be pregnant or lactating

• SITE: Single site    
• SETTING TYPE: Not specified    
• LOCATION: Large Midwestern cancer center

PHASE OF CARE: Active antitumor treatment

Experimental, pilot study, randomization to control group or experimental group

Skin toxicity grading by an RN using the acute radiation morbidity scoring criteria per Radiation Therapy Oncology Group (RTOG, 2009), a patient skin diary, a visual analog scale (VAS) for pain, a patient satisfaction questionnaire, a quality of life index, and skin type using the Pathak scale. Measurement points were at baseline, weekly during treatment (weeks one through six), and at a one-month follow-up visit (or week ten).

The authors reported that their pilot study showed no statistical difference in skin toxicity, pain, quality of life, or satisfaction in patients undergoing breast radiation and using either the essential oil mixture or RadiaPlexRx ointment on their skin.

The findings might support the application of an essential oil mixture as another potentially more cost-effective option for standard of care skin treatment during radiation therapy to the breast. The use of natural, organic ingredients might be well accepted by patients desiring \"natural\" treatment over traditional medications.

• The authors noted the limitation of the inability to truly blind subjects regarding their assigned skin preparation because of the strong smell associated with the essential oil mixture. The subjects and/or researchers may have known which topical emollient the subject was applying. 
• Missing data from half of the subjects were reported but were not related to measures used. A multiple imputation method was employed for twenty datasets. 
• Potential limitation: The study eligibility criteria required patients to speak English.

A larger sample size, inclusion of other cancer diagnoses, and non-English–speaking patients might provide more useful data to support the application of essential oil mixtures as an equivalent of the standard of care in treating the skin of patients undergoing radiotherapy.