SUPPORTIVE CARE
Aromatherapy
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Essential oils can be a great adjunct
to cancer care, aiding in the man-
agement of side effects, such as
insomnia and nausea. Healthcare
professionals should be knowl-
edgeable about the quality and
safety of essential oils when using
them for clinical purposes. Using
lesser quality essential oils and not
understanding safety guidelines
can negatively affect clinical
outcomes. This article provides
an overview of how nurses can
help patients with cancer safely
use essential oils as a supportive
therapy.
AT A GLANCE
ɔɔ Essential oils are a valuable
supportive therapy for health and
wellness.
ɔɔ Oncology nurses should learn
about essential oil quality and
precautions to help guide patients
using essential oils as part of their
plans of care.
ɔɔ Lavender, peppermint, and
orange are common, afford-
able essential oils that can help
support patients with cancer who
experience insomnia, nausea, and
anxiety.
KEYWORDS
chemotherapy; complemen-
tary/alternative therapies;
quality of life; aromatherapy
DIGITAL OBJECT
IDENTIFIER
10.1188/17.CJON.16-19
16   CLINICAL JOURNAL OF ONCOLOGY NURSING  VOLUME 21, NUMBER 1
Using essential oils as a supportive therapy
Debra Reis, RN, MSN, NP, and Tisha Jones, MSW
A
romatherapy (also re-
ferred to as “essential
oil therapy”) is defined
as “the art and science
of utilizing naturally
extracted aromatic essences from plants
to balance, harmonize and promote the
health of body, mind and spirit” (National
Association for Holistic Aromatherapy
[NAHA], 2016, p. 1). Essential oils are com-
plex mixtures of organic compounds that
have a basic carbon hydrogen framework
with added “functional groups” (Buckle,
2015; Tisserand & Young, 2014), includ-
ing alcohols, aldehydes, esters, ethers,
ketones, and phenols (Buckle, 2015).
Much of essential oil research is focused
on chemical constituents and not on the
entire oil complex. However, many aro-
matherapists maintain that essential oils
are more than the sum of their parts and
that the entire oil should be reviewed in
relationship to its healing properties and
clinical applications.
Several cancer centers in the United
States are using clinical aromatherapy as
a supportive modality (Buckle, 2015; Seely,
Weeks, & Young, 2012). Giraud-Roberts
(2009) advocated the use of aromathera-
py in cancer care to aid a person’s quality
of life and limit the side effects of cancer
therapies. When using aromatherapy in a
clinical setting, safety and oil quality are
paramount. The purpose of this article is
to provide an overview of how nurses can
help patients with cancer safely use essen-
tial oils as a supportive therapy.
How to Use Essential Oils
Pharmacokinetics is the study of how
essential oils are absorbed and excret-
ed. According to Buckle (2015), essential
oil components can be absorbed by four
routes: inhalation, topical, internal (e.g.,
gargles, douches, suppositories), and oral
(e.g., capsules, dilutions in honey).
Inhalation is a simple yet effective
method to obtain an outcome in seconds.
A simple method of inhalation includes
putting a drop or two of oil on a tissue and
breathing in the aroma. Diffusion is a pro-
cess that disperses oils into the air, allow-
ing for better absorption of microdroplets
through the mucosa. Three ways to diffuse
oils into the air include the use of heat, wa-
ter, and atomizing, which is the preferred
method (Stewart, 2005).
A variety of ways exist to apply es-
sential oils to the body, including using
lotions, salves, salt scrubs, bath solubles,
and soaps. Essential oil dilution with a
carrier oil, such as organic coconut oil or
jojoba oil, is the preferred method for ap-
plication on the skin (Schnaubelt, 2011).
Patients should use essential oil internally
or orally only under the guidance of a cer-
tified aromatherapist.
Safety Guidelines
and Essential Oil Quality
Before using essential oils, patients must
understand safety and quality. General
safety guidelines are provided in Figure
1. According to Schnaubelt (1999), when
using essential oils for healing purpos-
es, patients should acquire oils through a
company that shares the vision of healing
versus a company whose primary focus is
economic gain. Many factors can affect the
quality of oil; therefore, consumers should
buy essential oils from companies that
use organic farming, monitor farming and
CJON.ONS.ORG
 ASSOCIATE EDITOR ASHLEY LEAK BRYANT, PhD, RN-BC, OCN®

FIGURE 1.
GENERAL ESSENTIAL OIL SAFETY GUIDELINES

ɔɔ Bottles of essential oil should be closed tightly after each use. and will float on top of the water, potentially causing burning or skin irritation.
ɔɔ Bottles of essential oil should always be kept out of reach of children and An emulsifier, such as a bath gel or bath salt, should be used as a carrier.
pets. ɔɔ Essential oils should not come in contact with mucous membranes or
ɔɔ Essential oils that contain high concentrations of menthol (e.g., peppermint) sensitive skin. Some essential oils may cause skin irritation and should be
should not be applied to the throat or neck of children younger than 30 diluted in a carrier oil. If an essential oil causes skin irritation, apply a small
months. amount of vegetable oil or cream to the affected area and discontinue use of
ɔɔ Essential oils should not be taken internally without appropriate aromathera- the essential oil or product.
py safety education. ɔɔ When using essentials oils, keep a carrier oil, such as coconut oil, available.
ɔɔ Some essential oils are phototoxic (e.g., orange); therefore, skin exposure to ɔɔ Use caution with people with allergies. Consider using a skin patch test and
ultraviolet light, both the sun and a tanning booth, should be avoided after allow for good room ventilation.
application. ɔɔ Use caution when using essential oil near the eye area. If essential oil gets
ɔɔ Essential oils are flammable; they should be kept away from direct contact into the eyes, apply a cotton ball or cloth imbued with a fatty oil, such as olive
with flames, such as candles, fire, matches, cigarettes, and gas cookers. or sesame, carefully over a closed eyelid.
ɔɔ Essential oils should not be diluted with water. If dilution is needed, use a
Note. Based on information from National Association for Holistic Aromatherapy, 2015;
carrier oil such as jojoba oil, sweet almond oil, or olive oil.
Pénöel & Pénöel, 1998; Smith, 2005.
ɔɔ Essential oils should not be added directly to bathwater. Oil is not water-soluble

distillation processes, conduct indepen-
dent testing, and adhere to quality stan-
dards. Only genuine essential oils should
be used for clinical and healing purposes.
Most (if not all) essential oils in the gen-
eral market have synthetic additives or
fractions removed (Price & Price, 2012).
In addition, the majority of essential oils
used for aromatherapy in the United
States are fabrications; the oils are not ex-
clusively from a single plant source, which
can significantly alter their composition
(Schnaubelt, 2011). The four types of es-
sential oils are:
ɐɐ Synthetic or nature-identical oils are
produced in a laboratory setting and are
often available in health food and novel-
ty stores. They have no therapeutic effi-
cacy and may cause harm.
ɐɐ Extended or altered oils are fragrance-
quality oils with a perfume aroma. These
oils are comprised of an essential oil base
but are enhanced with specific laboratory-
created constituents to increase volume
or fragrance.
ɐɐ Natural oils (organic) and certified oils
meet standard testing guidelines but
contain only a few (if any) therapeutic
compounds. These oils may be labeled
“100% pure” or “natural.”
ɐɐ Therapeutic-quality essential oils are
distilled so that all desired therapeutic
compounds are retained. Such oils are
often referred to as medicinal quality
or genuine essential oils (Life Science
Publishing, 2011).
Essential Oil Safety and Cancer
Some essential oils may reduce or en-
hance certain drugs’ effectiveness, de-
pending on the amount of oil used, the
strength of the oil, and the method of
use. Individuals with estrogen-dependent
cancers should avoid essential oils
with phytoestrogen-like activity, in-
cluding aniseed (Pimpinella anisum),
clary sage (Salvia sclarea), bitter fennel
(Foeniculum vulgare var. amara), sweet
fennel (Foeniculum vulgare var. dulce),
myrtle (Myrtus communis) and star anise
(Illicium verum) (Buckle, 2015). An in vi-
tro study on rats indicated that the essen-
tial oils peppermint (type unknown) and
eucalyptus (Eucalyptus globulus) should
not be used topically near an IV catheter
site administering 5-fluorouracil because
of a potential increase in absorption of
medication (Buckle, 2015).
During cancer treatment, skin changes
may occur. Therefore, skin testing an es-
sential oil, whether diluted or not, to ob-
serve for redness may be a prudent prac-
tice for topical application (Schnaubelt,
2011). Most skin reactions occur immedi-
ately, but some delayed reactions may not
be observed for as long as 24 hours after
application. In addition, essential oils or
blends should not be applied to skin areas
where topical medications have been ap-
plied. Information is not available on the
combination of a chemical medication and
organic essential oil on the same area of
skin, which may cause an unwanted reac-
tion (Buckle, 2015).
Essential Oils
for Supportive Care
Lavender (Lavandula angustifolia), pep-
permint (Mentha x piperita), and orange
(Citrus sinesis) are common essential oils
that can be used as adjuncts to a support-
ive plan of care for patients with cancer.
Lavender has been shown to help provide
a calming sensation to promote sleep,

CJON.ONS.ORG VOLUME 21, NUMBER 1  CLINICAL JOURNAL OF ONCOLOGY NURSING  17

SUPPORTIVE CARE
peppermint to help decrease nausea and
vomiting, and orange to lessen anxiety.
Lavender
Lavender, also known as true lavender or
English lavender, is made from flowers
with a steam-distilled method. The pri-
mary constituents of lavender are linalool
(monoterpene alcohol) and linalyl acetate
(ester). Monoterpene alcohols can have
a sedative effect, relieve discomfort, and
support immune function. Esters have
properties that are antispasmodic, relax-
ing, and balancing (Higley & Higley, 2012;
NAHA, 2015).
Lavender has been extensively studied
as a sleep aid. Patients with cancer often
experience insomnia, which may be relat-
ed to steroid treatment regimens, the in-
herent stress related to a cancer diagnosis,
and psychosocial issues related to family
and work. A systematic review of laven-
der’s effect on sleep (Fismer & Pilkington,
2012) included eight studies of lavender
administered by inhalation. Study partic-
ipants included hospitalized older adults,
other hospital patients, college students,
healthy individuals, and females. Although
most of these studies were small, the find-
ings suggest that lavender oil may have
a small to moderate beneficial effect on
sleep.
PRECAUTIONS
The labeling of lavender is a safety con-
cern because adulterations of lavender
are common and recognizing an adulter-
ated lavender oil from a genuine lavender
essential oil can be difficult (Schnaubelt,
1999). Lavandin (Lavandula x intermedia)
essential oil is from a hybrid plant and can
be labeled lavender in the United States;
however, the chemical constituents are
different and may cause skin irritation.
Lavender is known to be calming; howev-
er, too much lavender can have a stimulat-
ing effect (Price & Price, 2012). Lavender
should be used with caution if a person is
on medication for anxiety or depression,
as it may enhance the effects of these med-
ications (Buckle, 2015).
18   CLINICAL JOURNAL OF ONCOLOGY NURSING  VOLUME 21, NUMBER 1
Peppermint
Peppermint is steam distilled from leaves,
stems, and flower buds. The main chem-
ical constituents in peppermint are men-
thol (phenolic alcohol) and menthone
(ketone). Phenolic alcohols enhance the
immune system and strengthen the ner-
vous system, and ketones assist the body
with cell regeneration and liquefaction of
mucous (Higley & Higley, 2012; NAHA,
2015).
Nausea is reported as the primary
distressing symptom in patients under-
going chemotherapy, despite significant
improvements in antiemetic medication.
An estimated 70%–80% of patients re-
ceiving chemotherapy experience nausea
and vomiting (Lindley, Bernard, & Fields,
1989). One study (Tayarani-Najaran,
"Essential oils can be a valuable
supportive therapy, but nurses should be
aware of quality and safety precautions."
Talasaz-Firoozi, Nasiri, Jalali, &
Hassanzadeh, 2013) looked at ingesting
oils to help with chemotherapy-induced
nausea and vomiting, in which both pep-
permint (Mentha x piperita) and spear-
mint (Mentha spicata) were given orally
by capsule (filled with two drops of oil
and sugar) along with a normal antiemet-
ic regimen. The essential oil capsules
were administered 30 minutes before
chemotherapy initiation, four hours after
the first capsule, and four hours later at
home. The researchers concluded that
the patients who received either pepper-
mint or spearmint capsules had a statis-
tically significant (p < 0.05) reduction of
nausea and vomiting in the first 24 hours
compared to the placebo group, without
any adverse effects. No significant dif-
ferences existed between the two oils in
controlling vomiting, and the reported
cost of treatment was significantly lower
than the antiemetic (Tayarani-Najaran et
al., 2013).
PRECAUTIONS
Caution should be exercised when using
peppermint on the skin, as some peo-
ple have reported skin irritation (Price
& Price, 2012; Smith, 2005). Peppermint
should not be used by patients who have
atrial fibrillation (Tisserand & Balacs,
1995) or on children younger than 30
months (Schnaubelt, 1999; Smith, 2005).
Orange
Orange essential oil is expressed from the
peel (Price & Price, 2012). The main con-
stituent in orange oil is a monoterpene
called d-limonene. Monoterpenes are
found in 90% of citrus peel oils and have en-
ergizing qualities and immune-supporting
effects (Higley & Higley, 2012; NAHA,
2015).
Mood disorders, such as anxiety, stress,
and depression, are often experienced by
patients undergoing cancer therapy. An
estimated 24%–59% of patients with can-
cer experience cancer-related distress,
which can be caused by various factors
(Chandwani et al., 2012).
The anxiolytic effect of the sweet or-
ange aroma was studied in 40 healthy
men (Goes, Antunes, Alves, & Teixeira-
Silva, 2012). To elicit anxiety, the vol-
unteers took the video-monitored
Stroop Color and Word Test and in-
haled either sweet orange (Citrus si-
nesis), tea tree (Melaleuca alternifolia)
(aromatic control), or distilled water
(nonaromatic control) before the test.
Those who inhaled sweet orange showed
less anxiety as measured by the State-Trait
CJON.ONS.ORG
Anxiety Inventory. These results may be
beneficial to individuals experiencing anx-
iety in an oncology setting.
PRECAUTIONS
Many citrus plants are sprayed with pesti-
cides; therefore, patients should know the
source of oils and look for organic oils to
ensure the best quality. Orange essential
oil is phototoxic and should not be used
topically on any area of skin exposed to
ultraviolet light (e.g., sun, tanning booth).
Implications for Practice
Essential oils can be a great supportive
therapy for health and wellness. Oncology
nurses should be aware that patients may
use essential oils as supplements, which
may be contraindicated with specific med-
ications or conditions. They also should be
knowledgeable about essential oil quality
and safety to help guide patients in their
plans of care.
Lavender, peppermint, and orange are
well-known essential oils that have been
included in many study methodologies.
Nurses should understand essential oils
when reviewing the literature, because not
all studies provide the botanical/Latin name
of oils, making it unclear which specific oils
are used. In addition, some researchers use
synthetic or altered essential oils as part
of their methodology. The results of these
studies could be questioned because of the
additives in the essential oils, and many
clinical aromatherapists would be con-
cerned about patients with compromised
immune systems inhaling or applying syn-
thetic products. Because of clinical impli-
cations, researchers should clearly indicate
which essential oils are used and ensure
that oils are of therapeutic, organic quality
and are from reputable sources.
Conclusion
The NAHA is a recognized leader in aro-
matherapy and promotes essential oil ed-
ucation for the public, and the Alliance of
International Aromatherapists promotes
the education of aromatherapists and
healthcare professionals on the aspects
CJON.ONS.ORG
of essential oils. To learn more about
essential oil quality, safety, and uses,
visit www.naha.org and www.alliance
-aromatherapists.org.
Debra Reis, RN, MSN, NP, is the coordinator for
the Healing Care Program at the ProMedica Cancer
Institute and Tisha Jones, MSW, is a grant writer for
ProMedica in Toledo, OH. Reis can be reached at deb
.reis@promedica.org, with copy to CJONEditor@ons
.org.
The authors take full responsibility for this content and did
not receive honoraria or disclose any relevant financial
relationships.
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