Overview
Questions and Answers About Aromatherapy
Changes to This Summary (05/23/2008)
General CAM Information
Evaluation of CAM Approaches
Questions to Ask Your Health Care Provider About CAM
To Learn More About CAM

Overview

• Aromatherapy is the use of essential oils from plants to support and balance the mind, body, and spirit (see Question 1 ¹).
• Patients with cancer use aromatherapy mainly to improve their quality of life (see Question 1 ¹).
• Essential oils like Roman chamomile, geranium, lavender, and cedarwood are the basic materials of aromatherapy (see Question 1 ¹).
• Interest in aromatherapy grew in the late 20th century as a form of complementary medicine (see Question 2 ²).
• Aromatherapy may work by sending chemical messages to the part of the brain that affects moods and emotions (see Question 3 ³).
• Essential oils are most often used by inhaling them or by applying them to the skin (see Question 4 ⁴).
• Laboratory studies and animal studies have shown that certain essential oils have antibacterial, calming, or energizing effects (see Question 5 ⁵).
• Aromatherapy research with cancer patients has studied its effects on symptoms, anxiety, and stress (see Question 6 ⁶).
• Safety testing on essential oils has found very few bad side effects. Lavender and tea tree oils have been found to have some hormone -like effects. (See Question 7 ⁷.)
• Aromatherapy products do not need approval by the U.S. Food and Drug Administration because no specific medical claims are made (see Question 8 ⁸).

Questions and Answers About Aromatherapy

1. What is aromatherapy?

   Aromatherapy is the use of essential oils from plants to support and balance the mind, body, and spirit. There is no evidence that aromatherapy cures or prevents cancer. It is used by patients with cancer mainly as a form of supportive care that may improve quality of life and reduce stress and anxiety. Aromatherapy may be combined with other complementary treatments like massage therapy and acupuncture, as well as with standard treatments.

   Essential oils (also known as volatile oils) are the basic materials of aromatherapy. They are made from fragrant essences found in many plants. These essences are made in special plant cells, often under the surface of leaves, bark, or peel, using energy from the sun and elements from the air, soil, and water. If the plant material is crushed, the essence and its unique fragrance are released.

   When essences are extracted from plants in natural ways, they become essential oils. They may be distilled with steam and/or water, or mechanically pressed. Oils that are made with chemical processes are not considered true essential oils.

   There are many essential oils used in aromatherapy, including Roman chamomile, geranium, lavender, tea tree, lemon, cedarwood, and bergamot. Each type of essential oil has a different chemical structure that affects how it smells, how it is absorbed, and how it is used by the body. Even varieties of plants within the same species may have chemical structures different from each other because they are grown or harvested in different ways or locations.

   Essential oils are very concentrated. For example, it takes about 220 lbs of lavender flowers to make about 1 pound of essential oil. Essential oils are very volatile, evaporating quickly when they come in contact with air.

2. What is the history of the discovery and use of aromatherapy as a complementary and alternative treatment for cancer?

   Fragrant plants have been used in healing practices for thousands of years across many cultures, including ancient China, India, and Egypt. Ways to extract essential oils from plants were first discovered during the Middle Ages.

   The history of modern aromatherapy began in the early 20th century, when French chemist Rene Gattefosse coined the term "aromatherapie" and studied the effects of essential oils on many kinds of diseases. In the 1980s and 1990s, aromatherapy was rediscovered in Western countries as interest in complementary and alternative medicine (CAM) began to grow.

3. What is the theory behind the claim that aromatherapy is useful in treating cancer?

   Aromatherapy is generally not suggested as a treatment for cancer, but as a form of supportive care to manage symptoms of cancer or side effects of cancer treatment. There are different theories about how aromatherapy and essential oils work. One theory is that smell receptors in the nose may respond to the smells of essential oils by sending chemical messages along nerve pathways to the brain's limbic system, which affects moods and emotions. Imaging studies in humans help show the effects of smells on the limbic system and its emotional pathways. Another theory suggests that because essential oils are extracted from whole aromatic plants, they have a life force or vitality that can affect the body in unique ways.

4. How is aromatherapy administered?

   Aromatherapy is most often used in one of two ways:

   • Inhalation (taking into the body by breathing). This can be done by using a diffuser or placing drops of essential oils near the patient.
   • Topical treatment (applied to the surface of the body), usually in a diluted form. This can be done by massaging with essential oils diluted in a carrier oil, or by using essential oils in bathwater, lotions, or dressings.

   Aromatherapy is rarely taken by mouth.

   There are some essential oils commonly chosen to treat specific conditions. However, the types of oils used and the ways they are combined may vary, depending on the experience and training of the aromatherapist. This lack of standard methods has led to conflicting research on the effects of aromatherapy.

5. Have any preclinical (laboratory or animal) studies been conducted using aromatherapy?

   Many studies of essential oils have found that they have antibacterial effects when applied to the skin. In addition, studies in rats have shown that different essential oils can be calming or energizing. When rats were exposed to certain fragrances under stressful conditions, their behavior and immune responses were improved.

   One study showed that after essential oils were inhaled, markers of the fragrance compounds were found in the bloodstream, suggesting that aromatherapy affects the body directly like a drug, rather than indirectly through the central nervous system.

6. Have any clinical trials (research studies with people) of aromatherapy been conducted?

   Clinical trials of aromatherapy have mainly studied its use in the treatment of stress, anxiety, and other health-related conditions in seriously ill patients. Several clinical trials of aromatherapy in patients with cancer have been published with mixed results.

   A few early studies have shown that aromatherapy may improve quality of life in patients with cancer. Some patients receiving aromatherapy have reported improvement in symptoms such as nausea or pain, and have lower blood pressure, pulse, and respiratory rates.

   Studies of massage with or without aromatherapy in cancer patients found that they had less anxiety and more restful sleep, although there is mixed evidence about whether aromatherapy itself adds to the benefits of massage therapy.

   A small study of tea tree oil as a topical treatment to clear antibiotic -resistant MRSA bacteria from the skin of hospital patients found that it was as effective as the standard treatment.

7. Have any side effects or risks been reported from aromatherapy?

   Safety testing on essential oils shows very few bad side effects or risks when they are used as directed. Some essential oils have been approved as ingredients in food and are classified as GRAS (generally recognized as safe) by the U.S. Food and Drug Administration, within specific limits. Eating large amounts of essential oils is not recommended.

   Allergic reactions and skin irritation may occur in aromatherapists or in patients, especially when essential oils are in contact with the skin for long periods of time. Sun sensitivity may develop when citrus or other oils are applied to the skin before sun exposure.

   Lavender and tea tree oils have been found to have some hormone -like effects. They have effects similar to estrogen (female sex hormone) and also block or decrease the effect of androgens (male sex hormones). Applying lavender and tea tree oils to the skin over a long period of time has been linked to breast enlargement in boys who have not yet reached puberty. It is not known if the use of lavender and tea tree oils is safe for women who have a high risk for breast cancer that is estrogen-receptive.

8. Is aromatherapy approved by the U.S. Food and Drug Administration (FDA) for use as a cancer treatment in the United States?

   Aromatherapy products do not need approval by the Food and Drug Administration because no specific claims are made for the treatment of cancer or other diseases.

   Aromatherapy is not regulated by state law, and there is no licensing required to practice aromatherapy in the United States. Professionals often combine aromatherapy training with another field in which they are licensed, for example, massage therapy, registered nursing, acupuncture, or naturopathy.

Changes to This Summary (05/23/2008)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

General CAM Information

Complementary and alternative medicine (CAM)—also referred to as integrative medicine—includes a broad range of healing philosophies, approaches, and therapies. A therapy is generally called complementary when it is used in addition to conventional treatments; it is often called alternative when it is used instead of conventional treatment. (Conventional treatments are those that are widely accepted and practiced by the mainstream medical community.) Depending on how they are used, some therapies can be considered either complementary or alternative. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease.

Unlike conventional treatments for cancer, complementary and alternative therapies are often not covered by insurance companies. Patients should check with their insurance provider to find out about coverage for complementary and alternative therapies.

Cancer patients considering complementary and alternative therapies should discuss this decision with their doctor, nurse, or pharmacist as they would any therapeutic approach, because some complementary and alternative therapies may interfere with their standard treatment or may be harmful when used with conventional treatment.

Evaluation of CAM Approaches

It is important that the same rigorous scientific evaluation used to assess conventional approaches be used to evaluate CAM therapies. The National Cancer Institute (NCI) and the National Center for Complementary and Alternative Medicine (NCCAM) are sponsoring a number of clinical trials (research studies) at medical centers to evaluate CAM therapies for cancer.

Conventional approaches to cancer treatment have generally been studied for safety and effectiveness through a rigorous scientific process that includes clinical trials with large numbers of patients. Less is known about the safety and effectiveness of complementary and alternative methods. Few CAM therapies have undergone rigorous evaluation. A small number of CAM therapies originally considered to be purely alternative approaches are finding a place in cancer treatment—not as cures, but as complementary therapies that may help patients feel better and recover faster. One example is acupuncture. According to a panel of experts at a National Institutes of Health (NIH) Consensus Conference in November 1997, acupuncture has been found to be effective in the management of chemotherapy-associated nausea and vomiting and in controlling pain associated with surgery. In contrast, some approaches, such as the use of laetrile, have been studied and found ineffective or potentially harmful.

The NCI Best Case Series Program ⁹, which was started in 1991, is one way CAM approaches that are being used in practice are being investigated. The program is overseen by the NCI’s Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer alternative cancer therapies submit their patients’ medical records and related materials to OCCAM. OCCAM conducts a critical review of the materials and develops follow-up research strategies for approaches deemed to warrant NCI-initiated research.

Questions to Ask Your Health Care Provider About CAM

When considering complementary and alternative therapies, patients should ask their health care provider the following questions:

• What side effects can be expected?
• What are the risks associated with this therapy?
• Do the known benefits outweigh the risks?
• What benefits can be expected from this therapy?
• Will the therapy interfere with conventional treatment?
• Is this therapy part of a clinical trial?
• If so, who is sponsoring the trial?
• Will the therapy be covered by health insurance?

To Learn More About CAM

National Center for Complementary and Alternative Medicine (NCCAM)

The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) facilitates research and evaluation of complementary and alternative practices, and provides information about a variety of approaches to health professionals and the public.

NCCAM Clearinghouse

Post Office Box 7923 Gaithersburg, MD 20898–7923

Telephone: 1–888–644–6226 (toll free) 301–519–3153 (for International callers)

TTY (for deaf and hard of hearing callers): 1–866–464–3615

Fax: 1–866–464–3616

E-mail: info@nccam.nih.gov

Web site: http://nccam.nih.gov

CAM on PubMed

NCCAM and the NIH National Library of Medicine (NLM) jointly developed CAM on PubMed, a free and easy-to-use search tool for finding CAM-related journal citations. As a subset of the NLM's PubMed bibliographic database, CAM on PubMed features more than 230,000 references and abstracts for CAM-related articles from scientific journals. This database also provides links to the Web sites of over 1,800 journals, allowing users to view full-text articles. (A subscription or other fee may be required to access full-text articles.) CAM on PubMed is available through the NCCAM Web site ¹⁰. It can also be accessed through NLM PubMed ¹¹ bibliographic database by selecting the "Limits" tab and choosing "Complementary Medicine" as a subset.

Office of Cancer Complementary and Alternative Medicine

The NCI Office of Cancer Complementary and Alternative Medicine (OCCAM) coordinates the activities of the NCI in the area of complementary and alternative medicine (CAM). OCCAM supports CAM cancer research and provides information about cancer-related CAM to health providers and the general public via the NCI Web site ¹².

National Cancer Institute (NCI) Cancer Information Service

U.S. residents may call the NCI Cancer Information Service toll free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 am to 4:30 pm. Deaf and hearing impaired callers with TTY equipment may call 1-800-332-8615. A trained Cancer Information Specialist is available to answer your questions.

Food and Drug Administration

The Food and Drug Administration (FDA) regulates drugs and medical devices to ensure that they are safe and effective.

Food and Drug Administration

5600 Fishers Lane

Rockville, MD 20857

Telephone: 1–888–463–6332 (toll free)

Web site: http://www.fda.gov/

Federal Trade Commission

The Federal Trade Commission (FTC) enforces consumer protection laws. Publications available from the FTC include:

• Who Cares: Sources of Information About Health Care Products and Services
• Fraudulent Health Claims: Don’t Be Fooled

Consumer Response Center

Federal Trade Commission

CRC-240

Washington, DC 20580

Telephone: 1-877-FTC-HELP (1-877-382-4357) (toll free)

TTY (for deaf and hearing impaired callers): 202-326-2502

Web site: http://www.ftc.gov/

Glossary Terms

The technique of inserting thin needles through the skin at specific points on the body to control pain and other symptoms. It is a type of complementary and alternative medicine.

A hypersensitive immune reaction to a substance that normally is harmless or would not cause an immune response in most people. An allergic response may cause harmful symptoms such as itching or inflammation or tissue injury.

A type of hormone that promotes the development and maintenance of male sex characteristics.

A laboratory experiment using animals to study the development and progression of diseases. Animal studies also test how safe and effective new treatments are before they are tested in people.

A substance that kills bacteria or stops them from growing and causing disease.

A drug used to treat infections caused by bacteria and other microorganisms.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

A type of complementary and alternative medicine that uses plant oils that give off strong pleasant aromas (smells) to promote relaxation, a sense of well-being, and healing.

Having an odor, which often is pleasant or spicy.

A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium.

A type of orange tree grown in Italy. The essential oil from the peel of this orange is used in perfume, to get rid of insects, and to flavor tea. Bergamot oil is also used in aromatherapy for depression, anxiety, and poor digestion. The scientific name for the bergamot orange tree is Citrus bergamia.

The force of circulating blood on the walls of the arteries. Blood pressure is taken using two measurements: systolic (measured when the heart beats, when blood pressure is at its highest) and diastolic (measured between heart beats, when blood pressure is at its lowest). Blood pressure is written with the systolic blood pressure first, followed by the diastolic blood pressure (for example 120/80).

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

An oil with little or no scent that is used to dilute or “carry” essential oils (scented liquid taken from plants).

A type of evergreen tree with hard fragrant wood that is a member of the cypress family. The oil from the wood is used in soaps, shampoos, bath salts, perfumes, aromatherapy, and to keep insects away. The scientific name is Juniperus virginiana. Also called Eastern red cedar and red cedar.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

CNS. The brain and spinal cord. Also called CNS.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called a clinical study.

CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices generally are not considered standard medical approaches. Standard treatments go through a long and careful research process to prove they are safe and effective, but less is known about most types of CAM. CAM may include dietary supplements, megadose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation. Also called CAM.

Practices often used to enhance or complement standard treatments. They generally are not recognized by the medical community as standard or conventional medical approaches. Complementary medicine may include dietary supplements, megadose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation.

In science, a substance that is made up of more than one ingredient.

To heal or restore health; a treatment to restore health.

To make something thinner, weaker, less concentrated, or less pure by adding something to it.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

The scented liquid taken from certain plants using steam or pressure. Essential oils contain the natural chemicals that give the plant its “essence” (specific odor and flavor). Essential oils are used in perfumes, food flavorings, medicine, and aromatherapy.

A type of hormone made by the body that helps develop and maintain female sex characteristics and the growth of long bones. Estrogens can also be made in the laboratory. They may be used as a type of birth control and to treat symptoms of menopause, menstrual disorders, osteoporosis, and other conditions.

A protein found inside the cells of the female reproductive tissue, some other types of tissue, and some cancer cells. The hormone estrogen will bind to the receptors inside the cells and may cause the cells to grow. Also called ER.

FDA. An agency in the U.S. federal government whose mission is to protect public health by making sure that food, cosmetics, and nutritional supplements are safe to use and truthfully labeled. The Food and Drug Administration also makes sure that drugs, medical devices, and equipment are safe and effective, and that blood for transfusions and transplant tissue are safe. Also called FDA.

A pleasant, sweet odor.

A type of plant that is native to southern Africa and has white, pink, purple, or red flowers and 3- to 5-lobed leaves. An essential oil that smells like roses is taken from the leaves and used in perfume, in mosquito repellants, and in aromatherapy to treat skin problems and to reduce stress. The scientific name is Pelargonium graveolens. Also called pelargonium.

One of many chemicals made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in the laboratory.

In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as x-rays (high-energy radiation), ultrasound (high-energy sound waves), and radio waves.

The activity of the immune system against foreign substances (antigens).

In medicine, refers to the act of taking a substance into the body by breathing.

Research done in a laboratory. These studies may use test tubes or animals to find out if a drug, procedure, or treatment is likely to be useful. Laboratory studies take place before any testing is done in humans.

A plant with aromatic leaves and flowers that is a member of the mint family. Oil from the flowers has been used in some cultures to treat certain medical problems, to keep insects away, and to wash in. It is also used in aromatherapy. Perillyl alcohol, a substance found in lavender, is being studied in cancer prevention and treatment. The scientific name is Lavandula angustifolia. Also called English lavender and true lavender.

A small, yellow citrus fruit that is a source of citric acid and ascorbic acid (vitamin C). The juice is used to flavor food and drink and to prevent scurvy. Lemon oil (scented liquid taken from the peel) is used in aromatherapy. The scientific name of the lemon tree is Citrus limon.

A network of structures in the brain involved in memory and emotions.

A treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Massage therapy may help people relax, relieve stress and pain, lower blood pressure, and improve circulation. It is being studied in the treatment of cancer symptoms such as lack of energy, pain, swelling, and depression.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

A type of chamomile plant with daisy-like white flowers that is found in Europe, North America, and Argentina. The dried flowers are used in teas to calm and relax, to improve sleep, and to help with stomach problems. Its essential oil (scented liquid taken from plants) is used in perfumes, shampoos, face creams, lotions, and aromatherapy. The scientific names are Chamaemelum nobile and Anthemis nobilis. Also called English chamomile.

When referring to a medical test, sensitivity refers to the percentage of people who test positive for a specific disease among a group of people who have the disease. No test has 100% sensitivity because some people who have the disease will test negative for it (false negatives).

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

In medicine, treatment that experts agree is appropriate, accepted, and widely used. Health care providers are obligated to provide patients with standard therapy. Also called standard of care or best practice.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called palliative care, comfort care, and symptom management.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

A tree that is a member of the myrtle family. Oil from the tea tree is used in shampoos and skin care products and to treat skin infections. It has been used in some cultures to treat other skin conditions, including acne, burns, and insect bites. The scientific name is Melaleuca alternifolia.

On the surface of the body.