Aromatherapy in Oncology Nursing: Evidence, Safety, and Clinical Application | Megha Shah, DNP, FNP, OCN
Aromatherapy is one of the most frequently requested complementary interventions by patients in the oncology setting. Patients ask about it in the infusion chair. Families bring diffusers. Nurses get asked whether it is safe, whether it works, and whether they should discourage it or support it.
The honest answer is that the evidence base is modest but growing, the safety considerations are real and worth knowing, and dismissing it out of hand does not serve patients well. This is a topic I have spoken about at national conferences and one I get asked about regularly by nurses who want to give patients a thoughtful, grounded response rather than a blanket yes or no.
This article is that response.
What Aromatherapy Is, and What It Is Not
Aromatherapy is the therapeutic use of essential oils derived from plants for symptom management and wellness support. It is classified as a complementary therapy, meaning it is intended to be used alongside conventional treatment, not in place of it.
Essential oils can be administered in several ways: inhalation (via a diffuser, a personal inhaler, or direct application to a tissue), topical application (diluted in a carrier oil), or, in some traditions, internal use, though internal use is not recommended in clinical settings and is outside the scope of practice for nursing.
In oncology, aromatherapy is most often used for nausea and vomiting, anxiety and psychological distress, and cancer-related fatigue. These are the three areas with the most published evidence, and they are also three of the most common symptoms nurses manage in the infusion center.
What the Research Shows
Nausea and vomiting. This is the area with the most clinical interest and probably the most studied application of aromatherapy in oncology. Peppermint and ginger essential oils have received the most attention.
A systematic review published in the Clinical Journal of Oncology Nursing found that inhaled peppermint oil was associated with meaningful reductions in nausea severity in postoperative and chemotherapy-induced nausea, with a favorable safety profile. A study in the Journal of Perianesthesia Nursing found that patients using peppermint aromatherapy required fewer antiemetic medications compared to placebo, though the study population was mixed and the effect sizes were modest.
Ginger aromatherapy has shown similar promise in small trials, though the research quality is more variable. The proposed mechanism is that inhalation of these compounds activates olfactory receptors that may modulate the nausea response through the limbic system. This is plausible but not yet well characterized at the molecular level.
The clinical takeaway for nurses: aromatherapy is not a substitute for antiemetic therapy. Patients on emetogenic chemotherapy regimens still need appropriate pharmacologic antiemetic coverage, including 5-HT3 antagonists and, where indicated, NK1 receptor antagonists, dexamethasone, and olanzapine as part of multimodal regimens. Aromatherapy can be offered as an adjunct for breakthrough nausea or for patients who prefer a non-pharmacologic option for mild symptoms between doses.
Anxiety and psychological distress. Lavender is the most studied essential oil for anxiety across multiple patient populations, and the oncology literature includes several small trials that suggest benefit. A randomized controlled trial examining lavender aromatherapy in patients receiving chemotherapy found statistically significant reductions in self-reported anxiety compared to control, with effects that persisted for several hours post-infusion.
Bergamot and Roman chamomile have also been studied in oncology populations, with generally positive findings for anxiety and mood, though sample sizes are consistently small and methodological quality varies.
For nurses, the practical implication is straightforward. Offering patients a lavender-scented tissue or personal aromatherapy inhaler at the start of an infusion is a low-cost, low-risk intervention that may help reduce anticipatory anxiety, one of the most common and most undertreated aspects of chemotherapy infusion experiences.
Cancer-related fatigue. This is the weakest area of evidence for aromatherapy, and I want to be honest about that. Several studies have examined rosemary and peppermint oils for fatigue, with mixed results. The challenge is that cancer-related fatigue is multifactorial and not easily shifted by a single intervention. Aromatherapy is unlikely to significantly impact fatigue driven by anemia, myelosuppression, hypothyroidism, depression, or poor sleep, all of which require assessment and targeted management.
Where aromatherapy may have a role in fatigue is in supporting the psychological experience of fatigue: reducing the anxiety and low mood that often accompany it and that can amplify its subjective severity. That is not nothing, but it should be framed accurately to patients.
Safety Considerations for the Infusion Setting
This is where I want to spend some time, because safety considerations in a shared clinical space are more complex than safety considerations for individual home use.
Airborne allergens and respiratory sensitivity. Patients receiving chemotherapy frequently have mucositis, reactive airways, or heightened sensitivity to odors, particularly during treatment. What smells pleasant to one patient can trigger nausea or respiratory irritation in another. In a shared infusion space, diffusing essential oils into the shared air is not appropriate without explicit consent from all patients in the area. Personal aromatherapy inhalers, small tubes to which the patient holds to their own nose, are the safer, more controlled option for clinical use.
Photosensitivity. Several citrus-derived essential oils, including bergamot and lemon, are phototoxic when applied topically and then exposed to UV light. This is relevant for patients who are receiving radiation concurrent with systemic therapy. Nurses should advise patients against applying these oils to skin before sun exposure or before any radiation fields.
Drug interactions. Some essential oils have known or theoretical interactions with cytochrome P450 enzymes involved in drug metabolism. Grapefruit is the most documented example in oncology, but several other plant compounds share this metabolic pathway. Nurses should encourage patients to disclose all complementary therapies, including aromatherapy, to the treating team so that interactions can be evaluated.
Latex cross-reactivity. Tea tree oil has been associated with allergic reactions in some patients, and there is documented cross-reactivity with latex in sensitized individuals. In an oncology setting where patients may have a history of latex allergy from previous surgeries, this is worth noting.
Skin integrity. Undiluted essential oils applied directly to the skin can cause contact dermatitis. Patients receiving chemotherapy may already have compromised skin integrity, and topical aromatherapy use should be limited to appropriately diluted preparations.
How to Talk to Patients About Aromatherapy
Many patients arrive at the infusion center already using essential oils at home. The goal is not to discourage them but to ask about it, assess for safety concerns, and offer evidence-based guidance that respects their preferences.
A few practical questions to include in the complementary therapy conversation:
What essential oils are you using, and how are you using them, inhaled, topical, or otherwise?
Are you applying anything to your skin before coming to the infusion center?
Have you told your oncologist about your use of complementary therapies?
Normalizing the question makes patients more likely to disclose. And disclosure allows the care team to catch any concerns before they become problems.
For nurses who want to offer aromatherapy as part of symptom management in the infusion setting, the most practical entry point is personal inhalers with peppermint or lavender. They are low-cost, easy to standardize, and do not affect the shared environment. Some infusion centers stock them as routine supplies; others do not. If yours does not, it is worth raising through your quality improvement or shared governance structure. Please follow institutional guidelines at all times.
The evidence base for aromatherapy in oncology is not at the level of a first-line intervention. But complementary therapy and evidence-based care are not opposites. Meeting patients where they are, supporting what is safe, and teaching what we actually know, that is good clinical practice regardless of the intervention category.