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The Effectiveness of
Aromatherapy in Clients with
Cancer in Reducing Fatigue
and Improving Sleep Quality
Presented by Jeremy Pierce, MOTS
Objectives
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Background
Objective
Search Methods
Summary of Study Procedures
Methodological Quality
Results
My Conclusions
BACKGROUND
What is Cancer?
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Life threatening tumor invades body
tissues
Many different forms of disease
Many causes for cancer
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Alcohol & tobacco use
Dietary factors
Genetic factors
Demographic Data on Cancer
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Growing problem in U.S.
Prevalence—12 million
2011 projections
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1.5 million new cases of cancer
500,000 cancer-related deaths
Traditional Treatment
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Radiation therapy
Chemotherapy
Surgery
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Side-effects
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Anxiety
Depression
Fatigue
Insomnia
Pain
Cancer-Related Fatigue
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Symptom of cancer or side-effect of tx
96% of clients with cancer
Usually doesn’t resolve after tx
Usually not screened for
Associated with poor sleep quality
Treatments for Fatigue
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Energy conservation and activity
management
Psychosocial support (CBT)
CAM
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Aromatherapy
Hatha yoga
Meditation
Aromatherapy
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Uses aromatic essential oils
Can be used to relieve hundreds of
symptoms
Many types of oils used
Different methods
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Massage
Inhalation
Soaking
Physiological Mechanism
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Exact mechanism is unknown
Oils are similar in structure to cell
membranes, which helps them get
into the bloodstream
Aroma activates olfactory nerve
Justification for Evidence Review
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Cancer is a growing problem
Cancer-related fatigue is a common
symptom in clients with cancer
Aromatherapy is being used to tx cancerrelated fatigue
OBJECTIVE
The objective of this review is to examine
the extent to which the research literature
supports the use of aromatherapy as a more
effective approach to decreasing fatigue and
improving sleep quality in clients with
cancer.
SEARCH METHODS
Databases Searched
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CINAHL (EBSCOhost:
1994 to 10/8/11)
Google scholar (1992 to
10/2/11)
PubMed (1991 to
10/9/11)
Search Terms
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Aromatherapy
Cancer
Cancer-related fatigue
Fatigue
Inertia
Oncology
Physical Exhaustion
Sleep
SUMMARY OF STUDY
PROCEDURES
Types of Study Designs
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Individual randomized controlled trial – 4
Mixed method design – 1
Controlled clinical trial – 1
One group pre-post studies – 4
Populations Sampled
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Clients with cancer
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Breast cancer only – 1 study
Hematological malignancies – 1 study
Clients sampled from…
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Palliative- or cancer-care centers
1 study sampled from a hematology
transplant unit
Inclusion Criteria
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Age
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Minimum of 16-20 years – 4 studies
Maximum age of 70 in one study
Most studies did not have age criteria
Gender, race, & ethnicity—no criteria
Exclusion Criteria
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Individuals who used aromatherapy in
pass 6 months – 2 studies
Individuals using aromatherapy on their
own – 1 study
2 studies excluded individuals with mental
or cognitive disorders
Sample Sizes
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12 to 58 participants – 8 studies
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103 participants – 1 study
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313 participants – 1 study
Relevant Demographics
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Age
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Age range – 17 to 93 years
Average age – 51 to 73 years
Gender
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Majority female – 6 studies
Majority male – 3 studies
Gender information not given – 1 study
Experimental Interventions
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Method
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Aromatherapy massage – 7 articles
Inhalation aromatherapy – 2 articles
Footsoak and reflexology – 1 article
Oils used
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Varied, but half used lavender
4 let client’s choose
Number and Duration of
Intervention Sessions
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Number
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3-5 sessions – 5 studies
1 session – 2 studies
Other studies varied or did not indicate #
Duration – 15 to 60 minutes
Types of Outcome Measures
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3 studies used the Profile of Mood States
2 studies used unnamed assessments
Other studies used other assessments
METHODOLOGICAL
QUALITY
Threats to Validity
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No control group
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Pre-post studies
Three acknowledged this
Mortality and attrition
Inadequate information
Low Sample Size
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Imanishi et al. (2009) & Kohara et al.
(2004) had sizes of 12 & 20
Three studies had total sample sizes over
40, but intentions groups had sizes of 23
or less
Wilkinson et al. (1999) stated they needed
a larger sample
Psychometric Properties of
Assessments
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2 used non-standardized tests
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Kite et al. (2008)
Stringer and Donald (2008)
Wilkinson et al. (1999) used a subtest only
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Not psychometrically evaluated
RESULTS
Pre-Post Studies
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Pre-post studies showed decreased fatigue
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Kohara et al. (2004): p < 0.001
Stringer et al. (2008) & Wilkinson et al.
(1999): p < 0.05
Imanishi et al. (2009), Kite et al. (1998), &
Stringer & Donald (2011): no p-values
Aromatherapy vs. Massage Only
vs. Control
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Aromatherapy massage vs. control group
& massage only vs. control group
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3 studies showed significant improvements
(p < 0.05)
1 study showed no improvement
(Wilcock, 2004)
Aromatherapy massage vs. massage only
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Stringer et al. (2008) & Wilkinson et al.
(1999) using p < 0.005 and < 0.0001 showed
no improvement.
Long-Term Effects of
Aromatherapy
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Aromatherapy vs. CBT (Serfaty et al.,
2011)
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Short-term: aromatherapy massage > CBT
Long-term (3 months & 6 months):
aromatherapy < CBT
No p-value reported, but significance stated
Imanishi et al. (2009)
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Showed favorable results 3 months out
Did not report significance
Aromatherapy Not Beneficial
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Wilcock et al., 2004
Graham et al., 2003
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Put essential oils on bibs for clients to use
during radiation treatment
Found that fatigue got worse for control
group and intervention group
MY CONCLUSIONS
Discussion
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Generally speaking, aromatherapy is
beneficial – 8 of 10 articles indicated this
However
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Many threats to validity and in these studies
Several studied did not report p-values
For aromatherapy massage, the benefits
appear to be due to the massage, not the
essential oils
Discussion cont’d
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Long-term vs. Short-term
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Long-term benefits not likely
Graham et al.
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Found that an association developed between
side-effects of treatment and the scent of the
essential oils
Implications For OT Practice
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Aromatherapy can be used by OT’s to:
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Reduce clients’ fatigue to improve energy for
participation in occupations
Improve clients’ sleep participation
Practitioners must be aware of negative
associational effects of essential oils
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Do not provide aromatherapy during radiation
treatment
Implications for OT Practice,
cont’d
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OT’s must understand that effects of
aromatherapy are short-term
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Teach clients and caregivers how to perform
aromatherapy in the absence of the OT
Provide clients with aromasticks to help with
rest and sleep
Use aromatherapy massage
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Adjunct to massage
Client-centered
Implications for Future Research
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Aromatherapy needs more research
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Effects of aromatherapy on fatigue and sleep
quality are even more limited
Need research on OT interventions that
improve sleep participation
Which essential oils are beneficial?
References
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American Cancer Society. (2011a). Cancer facts and figures 2011. Retrieved
from http://www.cancer.org/acs/groups/content/
@epidemiologysurveilance/documents/document/acspc-029771.pdf
American Cancer Society. (2011b). The history of cancer. Retrieved from
http://www.cancer.org/Cancer/CancerBasics/TheHistoryofCancer
American Cancer Society. (2011c). Treatment types. Retrieved from
http://www.cancer.org/Treatment/TreatmentsandSideEffects/
TreatmentTypes/index
American Occupational Therapy Association. (2008). Occupational therapy
practice framework: Domain and process (2nd ed.). American Journal of
Occupational Therapy, 62, 625-683.
Anand, P., Kunnumakara, A.B., Sundaram, C., Harikumar, K.B., Tharakan,
T.T., Lai, O.S., … Aggarwal, B.B. (2008). Cancer is a preventable disease
that requires major lifestyle changes. Pharmaceutical Research, 25(9),
2097-2116.
Ancoli-Israel, S., Moore, P.J., & Jones, V. (2001). The relationship between
fatigue and sleep in cancer patients: A review. European Journal of Cancer
Care, 10(4), 245-255.
Barsevick, A.M., Dudley, W., Beck, S., Sweeney, C., Whitmer, K., & Nail, L.
(2004). A randomized clinical trial of energy conservation for patients with
cancer-related fatigue. Cancer, 100, 1302-1310.
References cont’d
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Center for Disease Control and Prevention. (2011). Cancer survivors: United
States, 2007. Morbidity and Mortality Weekly Report, 60(9), 269-296.
de Haes, J.C.J.M., Olschewski, M., Fayers, P., Visser, M.R.M., Cull, A.,
Hopwood, P., Sanderman, R. (1996). Measuring the quality of life of cancer
patients with the Rotterdam Symptom Checklist: A manual. Retrieved from
http://www.rug.nl/ gradschoolshare/research_tools/assessment_tools/
rscl_handleiding.pdf
Engstrom, C., Strohl, R.A., Rose, L., Lawandowski, L., & Stefanek, M.
(1999). Sleep alterations in cancer patients. Cancer Nursing, 22(2), 143148.
Essential Science Publishing. (1999). People’s desk reference for essential
oils. Orem, UT: Essential Science Publishing.
Graham, P.H., Browne, L., Cox, H., & Graham, J. (2003). Inhalation
aromatherapy during radiotherapy: Results of the placebo-controlled
double-blind randomized trial. Journal of Clinical Oncology, 12(12), 23722376.
Howlader, N., Noone, A.M., Krapcho, M., Neyman, N., Aminou, R., Waldron,
W., … Edwards, B.K. (Eds.). SEER cancer statistics review 1975-2008.
Retrieved from http://seer.cancer.gov/csr/1975_2008
References cont’d
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Imanishi, J., Kuriyama, H., Shigemori, I., Watanabe, S., Aihara, Y., Kita, M.,
… Fukui, K. (2009). Anxiolytic effect of aromatherapy massage in patients
with breast cancer. Evidence-based Complementary and Alternative
Medicine (eCAM), 6(1), 123-128.
Kite, S.M., Maher, E.J., Anderson, K., Young, T., Young, J., Wood, J., …
Bradburn, J. (1998). Development of an aromatherapy service at a cancer
centre. Palliative Medicine, 12, 171-180.
Kohara, H., Miyauchi, T., Suehiro, Y., Ueoka, H., Takeyama, H., & Morita, T.
(2004). Combined modality treatment of aromatherapy, foot soak, and
reflexology relieves fatigue in patients with cancer. Journal of Palliative
Medicine, 7(6), 791-796.
National Cancer Institute. (2007). Radiation therapy side effects. Retrieved
from http://www.cancer.gov/cancertopics/coping/radiation-therapy-andyou/page6
National Cancer Institute. (2011). Aromatherapy and essential oils (PDQ).
Retrieved from http://www.cancer.gov/cancertopics/pdq/cam/
aromatherapy/healthprofessional/page4
References cont’d
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National Cancer Institute. (n.d.a). A to Z list of cancers. Retrieved from
http://www.cancer.gov/cancertopics/types/alphalist
National Cancer Instiute (n.d.b). Chemotherapy side effects fact sheet.
Retrieved from http://wwwcancer.gov/cancertopics/coping/chemo-sideeffects
Serfaty, M., Wilkinson, S., Freeman, C., Mannix, K., & King, M. (2011). The
ToT study: Helping with Touch or Talk (ToT): A pilot randomized controlled
trial to examine the clinical effectiveness of aromatherapy massage versus
cognitive behaviour therapy for emotional distress in patients in
cancer/palliative care. Psycho-Oncology. Advance online publication. doi:
10.1002/pon.1921
Silver, J.K., & Gilchrist, L.S. (2011). Cancer rehabilitation with a focus on
evidence-based outpatient physical and occupational therapy interventions.
American Journal of Physical Medicine and Rehabilitation 90(5), S5-S15.
Soden, K., Vincent, K., Craske, S., Lucas, C., & Ashley, S. (2004). A
randomized controlled trial of aromatherapy massage in a hospice setting.
Palliative Medicine, 18(2), 87-92.
References cont’d
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Sood, A., Barton, D.L., Bauer, B.A., & Loprinzi, C.L. (2007). A critical review
of complementary therapies for CRF. Integrative Cancer Therapies, 6(1),
8-13.
Stringer, J., & Donald, G. (2011). Aromasticks in cancer care: An innovation
not to be sniffed at. Complementary Therapies in Clinical Practice, 17, 116121.
Stringer, J., Swindell, R., & Dennis, M. (2008). Massage in patients
undergoing intensive chemotherapy reduces serum cortisol and prolactin.
Psycho-Oncology, 17, 1024-1031.
University of Idaho College of Science. (2004). Amygdala. Retrieved from
http://www.sci.uidaho.edu/med532/amygdala.htm
Wilcock, A., Manderson, M., Weller, R., Walker, G., Carr, D., Carey, A.,
Broadhurst, D., … Ernst, E. (2004). Does aromatherapy massage benefit
patients with cancer attending a specialist palliative care day centre?.
Palliative Medicine, 18, 287-290.
Wilkinson, S., Aldridge, J., Salmon, I., Cain, E., & Wilson, B. (1999). An
evaluation of aromatherapy massage in palliative care. Palliative Medicine,
13, 409-417.