Maddocks-Jennings, W., Wilkinson, J. M., Cavanagh, H. M., & Shillington, D. (2009). 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: The Official Journal of European Oncology Nursing Society, 13(2), 87-93. doi:10.1016/j.ejon.2009.01.002

Study Purpose

Determine the effect of essential oil mouth rinse on mucositis onset, pain, and oral symptoms; weight loss

Intervention Characteristics/Basic Study Process

Patients were randomized to treatment, placebo, and control groups. Placebo and intervention groups were given solutions in 25 mL amber bottles with dropper caps. Patients in the treatment group were provided with a 1:1 mix of manuka and kanuka oils; placebo was sterile water. The participants further diluted and gargled for at least 15 seconds, then spit out. Then a fresh prep of same dilution was swallowed. This was started two days before radiation treatment began, and continued until one week after the completion of radiotherapy. Patients were to gargle 30 minutes either before or after eating, smoking,or drinking and before and after each radiotherapy treatment. Control patients did usual care.

Sample Characteristics

The sample was comprised of 19 patients. Intervention n = 6, placebo n = 6, control n = 7. The mean age was 68.9, with a range of 45-81 years. Females active = 1; placebo = 4, males active = 5, placebo = 2, control = 7.

Diagnosis Information: all head and neck cancer; all undergoing non-palliative radiotherapy to the oropharyngeal area.

Other Key Characteristics: Mean radiation dose across groups ranged from 5933-6200 cGy.


Single site: Outpatient setting New Zealand; large center with 7-9% of new patients with head and neck dx/year

Study Design

Randomized placebo double-blind controlled trial

Measurement Instruments/Methods

Patient diary: pain score, medication use, oral symptoms, 10 point visual analogue score (pain) RTOG 0-4 scale; body weight post-discharge survey (dry mouth/cough; altered taste and appetite; excess secretion/nausea and vomiting rating on scale of 0-10)


All patients developed some mucositis. The active gargle group went the longest time before a reaction occurred (p = 0.05). Onset of pain was reported to be delayed in the treatment group; only 1% of patients had a weight decrease in the treatment group compared to a 5.2% loss in the control group and a 4.1% loss in the placebo group.


Because this was a feasibility study, there is no statistical analysis of the results. The results support the hypothesis that these oils may provide a positive effect on the development of mucositis, pain, and nutritional outcomes.


Small sample <30. Need for participants to adhere to gargling; frequent performance of intervention; multiple clinicians evaluated mucositis.

Nursing Implications

Further research is needed to determine the overall benefit of this intervention.