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The Effectiveness of Aromatherapy in Clients with Cancer in Reducing Fatigue and Improving Sleep The Effectiveness of Aromatherapy in Clients with Cancer in Reducing Fatigue and Improving Sleep Quality Presented by Jeremy Pierce, MOTS

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

BACKGROUND BACKGROUND

What is Cancer? n n n Life threatening tumor invades body tissues Many different What is Cancer? n n n Life threatening tumor invades body tissues Many different forms of disease Many causes for cancer Alcohol & tobacco use n Dietary factors n Genetic factors n

Demographic Data on Cancer n n n Growing problem in U. S. Prevalence— 12 Demographic Data on Cancer n n n Growing problem in U. S. Prevalence— 12 million 2011 projections 1. 5 million new cases of cancer n 500, 000 cancer-related deaths n

Traditional Treatment n n n Radiation therapy Chemotherapy Surgery n Side-effects Anxiety n Depression Traditional Treatment n n n Radiation therapy Chemotherapy Surgery n Side-effects Anxiety n Depression n Fatigue n Insomnia n Pain n

Cancer-Related Fatigue n n n Symptom of cancer or side-effect of tx 96% of Cancer-Related Fatigue n n n 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 n n n Energy conservation and activity management Psychosocial support (CBT) Treatments for Fatigue n n n Energy conservation and activity management Psychosocial support (CBT) CAM Aromatherapy n Hatha yoga n Meditation n

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

Physiological Mechanism n n n Exact mechanism is unknown Oils are similar in structure Physiological Mechanism n n n 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 n n n Cancer is a growing problem Cancer-related fatigue Justification for Evidence Review n n n 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 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 n n n CINAHL (EBSCOhost: 1994 to 10/8/11) Google scholar SEARCH METHODS Databases Searched n n n CINAHL (EBSCOhost: 1994 to 10/8/11) Google scholar (1992 to 10/2/11) Pub. Med (1991 to 10/9/11) Search Terms n n n n Aromatherapy Cancer-related fatigue Fatigue Inertia Oncology Physical Exhaustion Sleep

SUMMARY OF STUDY PROCEDURES SUMMARY OF STUDY PROCEDURES

Types of Study Designs n n Individual randomized controlled trial – 4 Mixed method Types of Study Designs n n Individual randomized controlled trial – 4 Mixed method design – 1 Controlled clinical trial – 1 One group pre-post studies – 4

Populations Sampled n Clients with cancer Breast cancer only – 1 study n Hematological Populations Sampled n Clients with cancer Breast cancer only – 1 study n Hematological malignancies – 1 study n n Clients sampled from… Palliative- or cancer-care centers n 1 study sampled from a hematology transplant unit n

Inclusion Criteria n Age Minimum of 16 -20 years – 4 studies n Maximum Inclusion Criteria n Age Minimum of 16 -20 years – 4 studies n Maximum age of 70 in one study n Most studies did not have age criteria n n Gender, race, & ethnicity—no criteria

Exclusion Criteria n n n Individuals who used aromatherapy in pass 6 months – Exclusion Criteria n n n 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 n 12 to 58 participants – 8 studies n 103 participants – Sample Sizes n 12 to 58 participants – 8 studies n 103 participants – 1 study n 313 participants – 1 study

Relevant Demographics n Age range – 17 to 93 years n Average – 51 Relevant Demographics n Age range – 17 to 93 years n Average – 51 to 73 years n n Gender Majority female – 6 studies n Majority male – 3 studies n Gender information not given – 1 study n

Experimental Interventions n Method Aromatherapy massage – 7 articles n Inhalation aromatherapy – 2 Experimental Interventions n Method Aromatherapy massage – 7 articles n Inhalation aromatherapy – 2 articles n Footsoak and reflexology – 1 article n n Oils used Varied, but half used lavender n 4 let client’s choose n

Number and Duration of Intervention Sessions n Number 3 -5 sessions – 5 studies Number and Duration of Intervention Sessions n Number 3 -5 sessions – 5 studies n 1 session – 2 studies n Other studies varied or did not indicate # n n Duration – 15 to 60 minutes

Types of Outcome Measures n n n 3 studies used the Profile of Mood Types of Outcome Measures n n n 3 studies used the Profile of Mood States 2 studies used unnamed assessments Other studies used other assessments

METHODOLOGICAL QUALITY METHODOLOGICAL QUALITY

Threats to Validity n No control group Pre-post studies n Three acknowledged this n Threats to Validity n No control group Pre-post studies n Three acknowledged this n n n Mortality and attrition Inadequate information

Low Sample Size n n n Imanishi et al. (2009) & Kohara et al. Low Sample Size n n n 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 n 2 used non-standardized tests Kite et al. (2008) n Psychometric Properties of Assessments n 2 used non-standardized tests Kite et al. (2008) n Stringer and Donald (2008) n n Wilkinson et al. (1999) used a subtest only n Not psychometrically evaluated

RESULTS RESULTS

Pre-Post Studies n Pre-post studies showed decreased fatigue n n n Kohara et al. Pre-Post Studies n Pre-post studies showed decreased fatigue n n n 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 n Aromatherapy massage vs. control group & massage Aromatherapy vs. Massage Only vs. Control n Aromatherapy massage vs. control group & massage only vs. control group 3 studies showed significant improvements (p < 0. 05) n 1 study showed no improvement (Wilcock, 2004) n n Aromatherapy massage vs. massage only n Stringer et al. (2008) & Wilkinson et al. (1999) using p < 0. 005 and < 0. 0001 showed no improvement.

Long-Term Effects of Aromatherapy n Aromatherapy vs. CBT (Serfaty et al. , 2011) Short-term: Long-Term Effects of Aromatherapy n Aromatherapy vs. CBT (Serfaty et al. , 2011) Short-term: aromatherapy massage > CBT n Long-term (3 months & 6 months): aromatherapy < CBT n No p-value reported, but significance stated n n Imanishi et al. (2009) Showed favorable results 3 months out n Did not report significance n

Aromatherapy Not Beneficial n n Wilcock et al. , 2004 Graham et al. , Aromatherapy Not Beneficial n n Wilcock et al. , 2004 Graham et al. , 2003 Put essential oils on bibs for clients to use during radiation treatment n Found that fatigue got worse for control group and intervention group n

MY CONCLUSIONS MY CONCLUSIONS

Discussion n n Generally speaking, aromatherapy is beneficial – 8 of 10 articles indicated Discussion n n Generally speaking, aromatherapy is beneficial – 8 of 10 articles indicated this However Many threats to validity and in these studies n Several studied did not report p-values n For aromatherapy massage, the benefits appear to be due to the massage, not the essential oils n

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

Implications For OT Practice n Aromatherapy can be used by OT’s to: Reduce clients’ Implications For OT Practice n Aromatherapy can be used by OT’s to: Reduce clients’ fatigue to improve energy for participation in occupations n Improve clients’ sleep participation n n Practitioners must be aware of negative associational effects of essential oils n Do not provide aromatherapy during radiation treatment

Implications for OT Practice, cont’d n OT’s must understand that effects of aromatherapy are Implications for OT Practice, cont’d n OT’s must understand that effects of aromatherapy are short-term Teach clients and caregivers how to perform aromatherapy in the absence of the OT n Provide clients with aromasticks to help with rest and sleep n n Use aromatherapy massage Adjunct to massage n Client-centered n

Implications for Future Research n Aromatherapy needs more research n n n Effects of Implications for Future Research n Aromatherapy needs more research n n n 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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