Pimenta, F.C., Alves, M.F., Pimenta, M.B., Melo, S.A., de Almeida, A.A., Leite, J.R., . . . de Almeida, R.N. (2016). Anxiolytic effect of Citrus aurantium L. on patients with chronic myeloid leukemia. Phytotherapy Research, 30, 613–617.

To evaluate anxiety levels in patients with CML undergoing bone marrow biopsy who were exposed to the odor of C.aurantium essential oil versus those who were not

C. aurantium is an essential oil of the Citrus genus. In this study, participants were exposed to the essential oil odor via electronic diffuser. The study was divided into three groups. The first group received oral diazepam (10 mg), the second group was exposed to C. aurantium, and the third group was exposed to a placebo vaporized solution. In the second and third groups, exposure was 30 minutes long.

• N: 42   
• AGE: Adult average age of 45 (not further defined in article) 
• MALES (%): Not noted.   
• FEMALES (%): Not noted. 
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Adult patients with CML at any phase of the disease under regular treatment at research site.
• OTHER KEY SAMPLE CHARACTERISTICS: Both male and female patients with no history of psychiatric illness and a low level of anxiety at baseline were included. No other demographic data defined.

• SITE: Single site   
• SETTING TYPE: Not specified    
• LOCATION: Paraiba, Brazil

PHASE OF CARE: Multiple phases of care

Randomized controlled trial

State-Trait Anxiety Inventory (STAI) was used for subjective measurements. This is a self-reported anxiety scale. Physiological measurements including systolic and diastolic blood pressures, heart rate, and respiratory rate were also assessed.

The groups that received diazepam and exposure to C. aurantium both showed significant decrease in systolic blood pressure (p < 0.05). The group exposed to C. aurantium experienced significant decrease in heart rate (p < 0.001) as well as significant differences in anxiety levels as reported on the STAI-S before and after the treatment when analyzed by Wilcoxon test (p < 0.001).

Findings suggest that C. aurantium may potentiate anxiolytic effects in patients with CML undergoing bone marrow biopsy.

• Small sample (< 100)
• Risk of bias (sample characteristics)
• Key sample group differences that could influence results
• Measurement/methods not well described
• Findings not generalizable
• Other limitations/explanation: Patient demographics not fully defined; limited to patients with CML; methods could be defined in much better detail.

C. aurantium and other anxiolytic essential oils may be considered as nonpharmacologic tools for the reduction of anxiety in patients with cancer, although much more research is needed in more diverse patient populations.