The Effectiveness of Aromatherapy in Clients with Cancer in Reducing Fatigue and Improving Sleep Quality

1
The Effectiveness of Aromatherapy in Clients with
Cancer in Reducing Fatigue and Improving Sleep
Quality

• Presented by Jeremy Pierce, MOTS

2
Objectives

• Background
• Objective
• Search Methods
• Summary of Study Procedures
• Methodological Quality
• Results
• My Conclusions

3
BACKGROUND
4
What is Cancer?

• Life threatening tumor invades body tissues
• Many different forms of disease
• Many causes for cancer
• Alcohol tobacco use
• Dietary factors
• Genetic factors

5
Demographic Data on Cancer

• Growing problem in U.S.
• Prevalence12 million
• 2011 projections
• 1.5 million new cases of cancer
• 500,000 cancer-related deaths

6
Traditional Treatment

• Radiation therapy
• Chemotherapy
• Surgery

• Side-effects
• Anxiety
• Depression
• Fatigue
• Insomnia
• Pain

7
Cancer-Related Fatigue

• Symptom of cancer or side-effect of tx
• 96 of clients with cancer
• Usually doesnt resolve after tx
• Usually not screened for
• Associated with poor sleep quality

8
Treatments for Fatigue

• Energy conservation and activity management
• Psychosocial support (CBT)
• CAM
• Aromatherapy
• Hatha yoga
• Meditation

9
Aromatherapy

• Uses aromatic essential oils
• Can be used to relieve hundreds of symptoms
• Many types of oils used
• Different methods
• Massage
• Inhalation
• Soaking

10
Physiological Mechanism

• Exact mechanism is unknown
• Oils are similar in structure to cell membranes,
  which helps them get into the bloodstream
• Aroma activates olfactory nerve

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Justification for Evidence Review

• Cancer is a growing problem
• Cancer-related fatigue is a common symptom in
  clients with cancer
• Aromatherapy is being used to tx cancer-related
  fatigue

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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.

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SEARCH METHODS

• Databases Searched

• Search Terms

• CINAHL (EBSCOhost 1994 to 10/8/11)
• Google scholar (1992 to 10/2/11)
• PubMed (1991 to 10/9/11)

• Aromatherapy
• Cancer
• Cancer-related fatigue
• Fatigue
• Inertia
• Oncology
• Physical Exhaustion
• Sleep

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SUMMARY OF STUDY PROCEDURES
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Types of Study Designs

• Individual randomized controlled trial 4
• Mixed method design 1
• Controlled clinical trial 1
• One group pre-post studies 4

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Populations Sampled

• Clients with cancer
• Breast cancer only 1 study
• Hematological malignancies 1 study
• Clients sampled from
• Palliative- or cancer-care centers
• 1 study sampled from a hematology transplant unit

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Inclusion Criteria

• Age
• Minimum of 16-20 years 4 studies
• Maximum age of 70 in one study
• Most studies did not have age criteria
• Gender, race, ethnicityno criteria

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Exclusion Criteria

• 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

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Sample Sizes

• 12 to 58 participants 8 studies
• 103 participants 1 study
• 313 participants 1 study

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Relevant Demographics

• Age
• Age range 17 to 93 years
• Average age 51 to 73 years
• Gender
• Majority female 6 studies
• Majority male 3 studies
• Gender information not given 1 study

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Experimental Interventions

• Method
• Aromatherapy massage 7 articles
• Inhalation aromatherapy 2 articles
• Footsoak and reflexology 1 article
• Oils used
• Varied, but half used lavender
• 4 let clients choose

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Number and Duration of Intervention Sessions

• Number
• 3-5 sessions 5 studies
• 1 session 2 studies
• Other studies varied or did not indicate
• Duration 15 to 60 minutes

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Types of Outcome Measures

• 3 studies used the Profile of Mood States
• 2 studies used unnamed assessments
• Other studies used other assessments

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METHODOLOGICAL QUALITY
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Threats to Validity

• No control group
• Pre-post studies
• Three acknowledged this
• Mortality and attrition
• Inadequate information

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Low Sample Size

• 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

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Psychometric Properties of Assessments

• 2 used non-standardized tests
• Kite et al. (2008)
• Stringer and Donald (2008)
• Wilkinson et al. (1999) used a subtest only
• Not psychometrically evaluated

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RESULTS
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Pre-Post Studies

• Pre-post studies showed decreased fatigue
• Kohara et al. (2004) p lt 0.001
• Stringer et al. (2008) Wilkinson et al. (1999)
  p lt 0.05
• Imanishi et al. (2009), Kite et al. (1998),
  Stringer Donald (2011) no p-values

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Aromatherapy vs. Massage Only vs. Control

• Aromatherapy massage vs. control group massage
  only vs. control group
• 3 studies showed significant improvements (p lt
  0.05)
• 1 study showed no improvement (Wilcock,
  2004)
• Aromatherapy massage vs. massage only
• Stringer et al. (2008) Wilkinson et al. (1999)
  using p lt 0.005 and lt 0.0001 showed no
  improvement.

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Long-Term Effects of Aromatherapy

• Aromatherapy vs. CBT (Serfaty et al., 2011)
• Short-term aromatherapy massage gt CBT
• Long-term (3 months 6 months) aromatherapy lt
  CBT
• No p-value reported, but significance stated
• Imanishi et al. (2009)
• Showed favorable results 3 months out
• Did not report significance

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Aromatherapy Not Beneficial

• Wilcock et al., 2004
• Graham et al., 2003
• Put essential oils on bibs for clients to use
  during radiation treatment
• Found that fatigue got worse for control group
  and intervention group

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MY CONCLUSIONS
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Discussion

• Generally speaking, aromatherapy is beneficial
  8 of 10 articles indicated this
• However
• 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

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Discussion contd

• Long-term vs. Short-term
• Long-term benefits not likely
• Graham et al.
• Found that an association developed between
  side-effects of treatment and the scent of the
  essential oils

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Implications For OT Practice

• Aromatherapy can be used by OTs to
• 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
• Do not provide aromatherapy during radiation
  treatment

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Implications for OT Practice, contd

• OTs must understand that effects of aromatherapy
  are short-term
• 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
• Adjunct to massage
• Client-centered

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Implications for Future Research

• Aromatherapy needs more research
• 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?

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References

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References contd

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References contd

• Imanishi, J., Kuriyama, H., Shigemori, I.,
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