🔬 oncology

The Effectiveness of aromatherapy and its supportive Interventions on anxiety and pain among breast cancer patients: A systematic review and meta-analysis

This systematic review and meta-analysis of six randomized controlled trials suggests that aromatherapy, particularly when combined with music therapy, may effectively reduce pain and anxiety in breast cancer patients, although the supporting evidence is currently of low quality and warrants further research.

Original authors: Estervil, N. O., Carmichael, C. L., Feyissa, G. T.

Published 2026-06-18

📖 4 min read☕ Coffee break read

CC BY 4.0

Original authors: Estervil, N. O., Carmichael, C. L., Feyissa, G. T.

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ⚕️ This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer

Imagine your body is a house under renovation. For women with breast cancer, the "renovation" (surgery, chemotherapy, etc.) is necessary to fix the problem, but it often leaves the house feeling shaky, noisy, and full of stress. Two of the biggest complaints during this time are pain (the physical ache) and anxiety (the mental worry).

This paper is like a detective trying to figure out if a specific tool—aromatherapy (using scented plant oils)—can help calm the house down. The researchers didn't just guess; they gathered all the recent scientific studies (from 2015 to 2025) that tested this tool and combined their findings to see the big picture.

Here is what they found, broken down into simple concepts:

1. The Main Tool: Scented Oils

Think of aromatherapy as a "scented key." When you smell certain oils (like lavender, rose, or frankincense), the scent travels to the brain's "emotional control center" (the limbic system). It's like sending a gentle signal to the brain saying, "It's okay, relax."

2. The Results: Does the Key Work?

The researchers looked at 6 high-quality studies involving nearly 600 women. Here is the verdict:

For Anxiety (The Worry): The "scented key" works pretty well. On average, using aromatherapy lowered anxiety scores. It's like turning down the volume on a noisy radio. The study found that women felt less worried after using the oils compared to those who didn't.
For Pain (The Ache): The results are a bit mixed, like a dimmer switch that doesn't always work perfectly. Overall, aromatherapy did help reduce pain, but the effect wasn't as strong or consistent as it was for anxiety.
- The Catch: It didn't seem to work well for pain right before surgery (preoperative). It was more effective after the surgery was done.

3. The Super-Combo: Scent + Music

The paper discovered something interesting when they looked at what happens if you use the "scented key" plus another tool: music therapy.

Imagine trying to calm a stormy room. Using just a scent is like opening a window. Using just music is like playing a soothing song. But using both together is like opening the window and playing the song while turning on the lights.

The studies showed that combining aromatherapy with music was even more effective at reducing both pain and anxiety than using the scent alone.
However, the researchers noted that music alone seemed to be slightly better at calming anxiety than the scent alone, though both helped.

4. The "Quality of Evidence" Warning

This is the most important part of the paper. The authors put a big "Caution" sign on their findings. They rated the evidence as "Low-quality."

Why?

The Blindfold Problem: In many of the studies, the women knew they were smelling a nice scent. You can't really "blindfold" someone's nose. Because they knew they were getting the special treatment, they might have felt better just because they expected to (the placebo effect).
Small Groups: The studies didn't have huge numbers of people, making it hard to be 100% sure the results aren't just a fluke.
Different Scents: Some studies used lavender, others rose, others frankincense. It's like testing different brands of "calming keys" and trying to say they all work the same way.

5. The Bottom Line

The paper concludes that aromatherapy is a promising, low-cost helper for breast cancer patients, especially for reducing anxiety and post-surgery pain. It seems to work best when:

It is used after surgery (not right before).
It is combined with other soothing things like music or massage.

However, because the studies had some flaws (like the lack of blindfolds), the authors say we need more, better-designed research before doctors can say, "This is a guaranteed cure-all." For now, it's a helpful tool in the toolbox, but not the only tool needed.

Technical Summary: The Effectiveness of Aromatherapy and Supportive Interventions on Anxiety and Pain Among Breast Cancer Patients

Problem Statement
Breast cancer treatments, including surgery, chemotherapy, and hormone therapy, frequently induce significant physical and psychological side effects, notably pain and anxiety. These symptoms can impair physical functioning and quality of life. While non-pharmacological complementary and alternative medicine (CAM) therapies, such as aromatherapy, are increasingly utilized to manage these symptoms, existing evidence regarding their specific efficacy remains inconsistent. Previous reviews often conflate aromatherapy with other modalities or lack an updated synthesis of recent randomized controlled trials (RCTs). Consequently, there is a need to clarify the extent to which aromatherapy, both as a standalone intervention and in combination with other supportive therapies, effectively reduces pain and anxiety in breast cancer patients.

Methodology
This study is a systematic review and meta-analysis conducted according to the PRISMA 2020 guidelines.

Search Strategy: A comprehensive search was performed across PubMed, CINAHL, Cochrane Library, and SCOPUS for RCTs published between 2015 and 2025.
Inclusion Criteria: The review focused on adult women diagnosed with breast cancer. Eligible interventions included aromatherapy (essential oils via inhalation, topical application, or steam) administered alone or in combination with other CAM therapies (e.g., music, massage). Comparators included standard care, placebo, or other alternative treatments. Primary outcomes were pain and anxiety levels measured via validated scales.
Study Selection: From an initial pool of 84 studies, six RCTs met the inclusion criteria after screening for duplicates, relevance, and intervention specifics. The total sample size across these studies was 588 patients.
Data Analysis: Data were pooled using meta-analysis (Review Manager software). Depending on the number of studies, either fixed or random effects models were employed. Heterogeneity was assessed using the $I^2$ statistic and chi-squared test. The certainty of evidence was evaluated using the GRADE approach.
Quality Assessment: Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute (JBI) Critical Appraisal Tool for RCTs.

Key Contributions and Results
The review synthesized evidence from six studies conducted in Turkey, China, South Korea, Iran, and the United States. The most frequently used essential oil was lavender (67% of studies), followed by frankincense and rose.

Aromatherapy Alone:
- Anxiety: Meta-analysis indicated that aromatherapy reduced anxiety scores by an average of 0.53 units (SMD = -0.53, 95% CI: -0.90 to -0.16) compared to control conditions. However, the evidence was rated as low quality due to inconsistency and risk of bias (primarily lack of blinding).
- Pain: Aromatherapy reduced pain scores by an average of 0.79 units (SMD = -0.79, 95% CI: -1.42 to -0.16). The evidence was also rated as low quality. Notably, the effect on preoperative pain was not statistically significant, while postoperative effects varied across studies.
Combined Interventions (Aromatherapy + Music/Massage):
- Pain: The combination of aromatherapy and music therapy resulted in a significant reduction in pain scores (SMD = -1.26, 95% CI: -1.65 to -0.87) compared to standard care.
- Anxiety: The combination of aromatherapy and music therapy reduced anxiety scores by 1.08 units (SMD = -1.08, 95% CI: -1.45 to -0.70) compared to standard care.
- Comparative Effectiveness: When comparing aromatherapy directly to music therapy, music therapy demonstrated superior efficacy in reducing postoperative anxiety (SMD = 0.39, indicating higher anxiety in the aromatherapy group), though no significant difference was found for pain.
Methodological Limitations: The certainty of findings was downgraded to "low" or "very low" primarily due to the lack of blinding of participants and personnel (inherent to scent-based interventions), small sample sizes, and statistical heterogeneity ( $I^2$ up to 89.3%).

Significance and Claims
The authors conclude that there is a potential role for aromatherapy, particularly when combined with music therapy, in alleviating anxiety and pain for breast cancer patients, with the most consistent benefits observed in non-preoperative settings. The paper emphasizes that while aromatherapy shows promise as a low-cost, non-invasive complementary intervention, the current evidence base is limited by methodological weaknesses.

The study explicitly states that further high-quality research is required to:

Establish the independent efficacy of aromatherapy versus combination therapies.
Standardize essential oil selection, dosing protocols, and outcome measurement scales.
Address the lack of blinding in future trials to reduce bias.

The authors maintain a modest stance, noting that while the findings support the integration of aromatherapy into clinical care for anxiety and pain management, the evidence is not yet robust enough to definitively guide clinical practice without further validation. The review highlights the importance of multimodal approaches, suggesting that the synergistic effect of combining aromatherapy with other modalities like music or massage may yield greater therapeutic benefits than aromatherapy alone.

1. The Main Tool: Scented Oils

2. The Results: Does the Key Work?

3. The Super-Combo: Scent + Music

4. The "Quality of Evidence" Warning

5. The Bottom Line

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