Complementary Therapies in Clinical Practice xxx (2013) 1e4
Contents lists available at ScienceDirect
Complementary Therapies in Clinical Practice journal homepage: www.elsevier.com/locate/ctcp
The use of aromasticks at a cancer centre: A retrospective audit Jeannie Dyer a, *, Lise Cleary b, Maxine Ragsdale-Lowe b, Sara McNeill b, Caroline Osland a a b
Therapies Department, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK Therapies Department, The Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT, UK
a b s t r a c t Keywords: Aromasticks Aromatherapy inhaler devices Cancer Symptom control
Aim: To consider the use of aromasticks in a cancer centre in the UK: the reasons for their use, the choice of essential oils used in them and the demographics of the patients to whom they were given. Background: Aromasticks are personal aromatherapy inhaler devices, used in this hospital by the complementary therapy team to improve patients’ well-being and quality of life by helping with symptom control. Design: A retrospective audit of aromastick use covering a 28 month period from January 2011eApril 2013. Results: A total of 514 aromasticks were given out, to patients with a variety of cancer diagnoses and symptoms. The most common reasons for aromastick use were to alleviate nausea or to encourage relaxation. Lavender (Lavandula angustifolia), lemon (Citrus limon), frankincense (Boswellia carterii), bergamot (Citrus bergamia), orange sweet (Citrus sinensis) and peppermint (Mentha x piperita) were the essential oils used most often. Ó 2013 Elsevier Ltd. All rights reserved.
1. Introduction An aromastick is an individual plastic inhaler device containing an inner wick which is blank permitting the addition of essential oils. Once sealed, the device is held beneath the nose and inhaled, or the cap is closed when not required. Aromasticks are personalised, available to use wherever, whenever and for however long the individual wishes, and deep breathing and relaxation are encouraged in their use. The very limited amount of published evidence available supports the use of aromasticks with cancer patients. However we know from personal contacts with other complementary therapy teams that their use is widespread in hospitals, hospices and voluntary support centres. These small, portable, inexpensive devices would appear to offer a wide range of benefits and are popular with patients as a self-management tool. This audit therefore reports on our current practice, considering our reasons for the use of aromasticks, the choice of essential oils used and the demographics of the patients to whom they were given, from January 2011 to April 2013.
* Corresponding author. Markus Rehabilitation Centre, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK. Tel.: þ44 207 352 8171x1588; fax: þ44 207 808 2336. E-mail address: [email protected] (J. Dyer).
We have previously published two accounts specifically related to our aromastick use. Our first prospective survey looked generally at the reasons for aromastick use [1]. In this small audit, 13 (81%) of the patients who returned their surveys rated their aromastick “excellent”, “very good” or “good” at helping with symptom management. The second prospective survey looked more specifically at the effectiveness of aromasticks for attenuating nausea [2]. Fifty aromasticks were given to patients experiencing nausea for a variety of reasons. An improvement in nausea was seen in 34 records (68%). In addition, in a retrospective service evaluation of aromastick use within another acute cancer care setting [3], the authors found 123 (77%) of all patients in the evaluation reported deriving at least one benefit from the aromastick. The majority of aromasticks were given to patients for anxiety (31%), nausea (28%) and difficulty sleeping (19%). Of these, 80% of patients given an aromastick for anxiety found it beneficial, 82% of patients given one for nausea found it beneficial and 71% of patients given one for problems sleeping found it beneficial. Most of the published literature on fragrance use details research using experimental conditions involving administered fragrances and is not directly comparable to the use of aromasticks. However a search of the literature does reveal some papers relevant to fragrance use for symptom management, even though it is not specific to aromastick use. Researchers found evidence to suggest that inhaled peppermint oil may improve postoperative nausea in gynaecological patients [4]. However a recent Cochrane Review [5] concluded that there was currently no reliable evidence supporting
1744-3881/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ctcp.2013.11.006
Please cite this article in press as: Dyer J, et al., The use of aromasticks at a cancer centre: A retrospective audit, Complementary Therapies in Clinical Practice (2013), http://dx.doi.org/10.1016/j.ctcp.2013.11.006
2
J. Dyer et al. / Complementary Therapies in Clinical Practice xxx (2013) 1e4
the use of inhaled peppermint oil to treat postoperative nausea and vomiting. Two other studies, using ginger [6] and ginger, cardamom and tarragon [7], both found essential oils had a favourable effect on postoperative nausea and vomiting. A further study [8] found the inhalation of both ginger alone and a blend of ginger, spearmint, peppermint and cardamom, were effective as a treatment for postoperative nausea. Inhaled lavender was found to be anxiolytic for patients treated with haemodialysis [9]. In a larger randomised trial the ambient odours of both orange and lavender reduced anxiety in patients waiting for dental treatment [10]. Lavandula inhaled from a handkerchief was also found effective in significantly reducing anxiety in patients awaiting surgery [11]. A systematic review of randomised clinical trials was conducted to assess whether lavender is anxiolytic [12]. The authors found eight trials investigating the effect of lavender oil inhalation of which four reported a significantly positive effect for at least one anxiety outcome measure. On the other hand a study examining the effectiveness of essential oils in reducing anxiety in patients awaiting the results of thoracic investigative and staging surgery, did not find a neroli/ sandalwood blend to be effective in reducing anxiety [13]. Inhaled bergamot was not found to be effective for reducing anxiety, nausea or pain in children and adolescents undergoing stem cell infusion [14], and the inhalation of lavender, bergamot and cedarwood administered concurrently with radiotherapy was not found to be effective in reducing anxiety [15]. However a continuous application of citrus fragrance for patients with depressive illness was found to bring about a significant reduction in depression [16]. 1.1. Description of aromastick use at this cancer centre Any patient seen by the complementary therapies team at our centre, for any reason, may be offered, or may request, an aromastick. Essential oils for the aromasticks are chosen by the patients themselves in conjunction with the attending complementary therapist. All essential oils listed on the hospital’s Essential Oil Policy (see Table 1) are available for use in the aromasticks. Advice from the complementary therapists is based on their previous clinical experience, documented effects of odour inhalation in the literature, patients’ odour preferences and patients’ positive reaction to oils used in massage treatments. Therapists also carry two pre-blended mixes for nausea. These are the two blends which were chosen most often and found to be useful in one of our previous audits [2] namely: peppermint, ginger and lavender; and eucalyptus and lemon.
Table 1 Essential oils on the hospital’s Essential Oil Policy, available for use in the aromasticks. Bergamot (FCF) (Citrus bergamia) Black pepper (Piper nigrum) Black spruce (Picea mariana) Cardamom (Elettaria cardamomum) Cedarwood (Cedrus atlantica; Cedrus deodora) Chamomile, Roman (Chamaemelum nobile) Citronella (Cymbopogon nardus) Clary Sage (Salvia sclarea) Clove bud (Syzygium aromaticum) Cypress (Cupressus sempervirens) Eucalyptus (Lemon) (Eucalyptus citriodora) Eucalyptus (Eucalyptus globulus) Frankincense (Boswellia carterii) Geranium (Pelargonium graveolens) Ginger (Zingiber officinalis) Grapefruit (Citrus paradisi) Howood (Cinnamomum camphora) Immortelle (Helichrysum italicum) Lavender (Lavandula angustifolia) Lavender, spike (Lavandula latifolia) Lemon (Citrus limon)
Lemongrass (Cymbopogon citratus) Lime (Citrus aurantifolia) Mandarin (Citrus reticulata) Mandarin petitgrain (Citrus reticulata L. Blanco) Manuka (Leptospermum scoparium) Marjoram (Origanum majorana) Mint bergamot (Mentha citrata) Myrtle (Myrtus communis) Neroli (Citrus aurantium) Niaouli (Melaleuca quinquenervia) Orange (Sweet) (Citrus sinensis) Patchouli (Pogostemon cablin) Plai (Zingiber cassumunar Roxb) Peppermint (Mentha x piperita) Petitgrain (Citrus aurantium) Rose otto (Rosa damascena) Rosemary (Rosmarinus officinalis) Sandalwood (Santalum album; Santalum austrocaladonicum) Spearmint (Mentha spicata) Tea tree (Melaleuca alternifolia) Ylang-ylang Extra (Cananga odorata)
The choice of oils on the Essential Oil Policy reflects. currently available scientific research. the professional judgement of the Clinical Lead for Complementary Therapies. past experience of patient needs. the practicality of safely storing and using a limited quantity of oils. the cost of the oils. This is not a definitive list of essential oils that may be used on people with cancer. It is updated annually to take account of changing circumstances.
3.1. Patient demographics Female patients 401 (78%). Male patients 113 (22%). 3.2. Tumour group The proportion of patients from different cancer tumour groups who received aromasticks was: Haemato-oncology 157 (31%). Breast 113 (22%). Gynaecology 86 (17%). Gastrointestinal 57 (11%). Neuro-oncology 25 (5%). All other diagnoses each less than 5%.
2. Methodology
3.3. Reasons for giving aromasticks
The audit plan was approved by the hospital clinical audit committee. Sample: All aromasticks given to patients between January 2011 and April 2013. The documentation of aromastick use includes patient’s gender, cancer diagnosis, the reason why the aromastick was given and which essential oils were used. The data reviewed was collected from the documentation.
On our documentation of aromastick use (the Aromastick Record) the complementary therapists are able to write why they have given the aromastick in their own words. When analysing the Aromastick Record, we grouped the reasons for aromastick use into 16 categories representing both symptoms to be attenuated (eg nausea) and desirable states to be encouraged (eg relaxation) (see Table 2). We considered the number of times aromasticks were given for each symptom category and whether or not male and female patients were given aromasticks for similar reasons (see Table 3). Nausea was the most common reason an aromastick was given. Aromasticks given to encourage relaxation, particularly for female patients, was the second highest reason an aromastick was given, followed by anxiety, well-being and sleep problems. Anxiety was
3. Results Over this 28 month period 514 aromasticks were given out to patients as detailed below. All percentages throughout are rounded to the nearest whole number.
Please cite this article in press as: Dyer J, et al., The use of aromasticks at a cancer centre: A retrospective audit, Complementary Therapies in Clinical Practice (2013), http://dx.doi.org/10.1016/j.ctcp.2013.11.006
J. Dyer et al. / Complementary Therapies in Clinical Practice xxx (2013) 1e4 Table 2 Categories of symptom for aromastick use in oncology patients.
Table 4 Essential oils used most often in aromasticks given to oncology patients by complementary therapists.
Category
Examples of category
Nausea Relaxation Anxiety Well-being
To relieve or prevent nausea To help increase relaxation, reduce stress For help with anxiety, panic attacks, needle phobia To increase well-being, comfort, patient liked the smell, support, pleasure For poor sleep, insomnia Uplifting for low mood, depression, tearfulness For patients feeling short of breath, chesty or with blocked sinuses Fatigue For poor appetite, to enhance appetite To distract from pain or using same blend as that used in massage for pain (positive odour association) Headache Hot flushes possibly as distraction or for calming To mask malodour For claustrophobia in the MRI scanner Distraction (eg from itch) Dizziness
Sleep Low mood Short of breath Fatigue Low appetite Pain Headache Hot flushes Malodour Claustrophobia Distraction Dizziness
the only category in which there appeared to be a difference in proportions of aromasticks given to male and female patients. 3.4. Essential oils used in aromasticks The essential oil used most often was lavender (Lavandula angustifolia). Essential oils from the citrus and mint families as well as frankincense, ginger and eucalyptus were also used frequently. In addition to the 17 most used essential oils listed in Table 4, a further 20 essential oils were each used less than 25 times (in less than 5% of aromasticks). Most of the aromastick blends in this audit were individual combinations of essential oils blended by the complementary therapists to suit the patients’ symptoms and preferences. Only the four blends listed in Table 5 were used ten or more times. 4. Discussion The essential oil we used most often was lavender (Lavandula angustifolia); this may be because of its widely acceptable and familiar odour. As can be seen in Table 3, nausea was the most common reason an aromastick was given. In a previous audit we had looked specifically Table 3 Aromasticks given by complementary therapists: frequency of each category and patient gender. Category
Nausea Relaxation Anxiety Well-being Sleep Low mood Short of breath Fatigue Low appetite Pain Headache Hot flushes Malodour Claustrophobia Distraction Dizziness Total
Patient’s gender Female
Male
Total
112 85 57 38 36 20 17 13 11 4 2 2 1 1 1 1 401
33 18 17 12 12 3 5 4 4 2 2
145 103 74 50 48 23 22 17 15 6 4 2 2 1 1 1 514
(28%) (21%) (14%) (9%) (9%) (5%) (4%) (3%) (3%) (1%) (
Contents lists available at ScienceDirect
Complementary Therapies in Clinical Practice journal homepage: www.elsevier.com/locate/ctcp
The use of aromasticks at a cancer centre: A retrospective audit Jeannie Dyer a, *, Lise Cleary b, Maxine Ragsdale-Lowe b, Sara McNeill b, Caroline Osland a a b
Therapies Department, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK Therapies Department, The Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT, UK
a b s t r a c t Keywords: Aromasticks Aromatherapy inhaler devices Cancer Symptom control
Aim: To consider the use of aromasticks in a cancer centre in the UK: the reasons for their use, the choice of essential oils used in them and the demographics of the patients to whom they were given. Background: Aromasticks are personal aromatherapy inhaler devices, used in this hospital by the complementary therapy team to improve patients’ well-being and quality of life by helping with symptom control. Design: A retrospective audit of aromastick use covering a 28 month period from January 2011eApril 2013. Results: A total of 514 aromasticks were given out, to patients with a variety of cancer diagnoses and symptoms. The most common reasons for aromastick use were to alleviate nausea or to encourage relaxation. Lavender (Lavandula angustifolia), lemon (Citrus limon), frankincense (Boswellia carterii), bergamot (Citrus bergamia), orange sweet (Citrus sinensis) and peppermint (Mentha x piperita) were the essential oils used most often. Ó 2013 Elsevier Ltd. All rights reserved.
1. Introduction An aromastick is an individual plastic inhaler device containing an inner wick which is blank permitting the addition of essential oils. Once sealed, the device is held beneath the nose and inhaled, or the cap is closed when not required. Aromasticks are personalised, available to use wherever, whenever and for however long the individual wishes, and deep breathing and relaxation are encouraged in their use. The very limited amount of published evidence available supports the use of aromasticks with cancer patients. However we know from personal contacts with other complementary therapy teams that their use is widespread in hospitals, hospices and voluntary support centres. These small, portable, inexpensive devices would appear to offer a wide range of benefits and are popular with patients as a self-management tool. This audit therefore reports on our current practice, considering our reasons for the use of aromasticks, the choice of essential oils used and the demographics of the patients to whom they were given, from January 2011 to April 2013.
* Corresponding author. Markus Rehabilitation Centre, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK. Tel.: þ44 207 352 8171x1588; fax: þ44 207 808 2336. E-mail address: [email protected] (J. Dyer).
We have previously published two accounts specifically related to our aromastick use. Our first prospective survey looked generally at the reasons for aromastick use [1]. In this small audit, 13 (81%) of the patients who returned their surveys rated their aromastick “excellent”, “very good” or “good” at helping with symptom management. The second prospective survey looked more specifically at the effectiveness of aromasticks for attenuating nausea [2]. Fifty aromasticks were given to patients experiencing nausea for a variety of reasons. An improvement in nausea was seen in 34 records (68%). In addition, in a retrospective service evaluation of aromastick use within another acute cancer care setting [3], the authors found 123 (77%) of all patients in the evaluation reported deriving at least one benefit from the aromastick. The majority of aromasticks were given to patients for anxiety (31%), nausea (28%) and difficulty sleeping (19%). Of these, 80% of patients given an aromastick for anxiety found it beneficial, 82% of patients given one for nausea found it beneficial and 71% of patients given one for problems sleeping found it beneficial. Most of the published literature on fragrance use details research using experimental conditions involving administered fragrances and is not directly comparable to the use of aromasticks. However a search of the literature does reveal some papers relevant to fragrance use for symptom management, even though it is not specific to aromastick use. Researchers found evidence to suggest that inhaled peppermint oil may improve postoperative nausea in gynaecological patients [4]. However a recent Cochrane Review [5] concluded that there was currently no reliable evidence supporting
1744-3881/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ctcp.2013.11.006
Please cite this article in press as: Dyer J, et al., The use of aromasticks at a cancer centre: A retrospective audit, Complementary Therapies in Clinical Practice (2013), http://dx.doi.org/10.1016/j.ctcp.2013.11.006
2
J. Dyer et al. / Complementary Therapies in Clinical Practice xxx (2013) 1e4
the use of inhaled peppermint oil to treat postoperative nausea and vomiting. Two other studies, using ginger [6] and ginger, cardamom and tarragon [7], both found essential oils had a favourable effect on postoperative nausea and vomiting. A further study [8] found the inhalation of both ginger alone and a blend of ginger, spearmint, peppermint and cardamom, were effective as a treatment for postoperative nausea. Inhaled lavender was found to be anxiolytic for patients treated with haemodialysis [9]. In a larger randomised trial the ambient odours of both orange and lavender reduced anxiety in patients waiting for dental treatment [10]. Lavandula inhaled from a handkerchief was also found effective in significantly reducing anxiety in patients awaiting surgery [11]. A systematic review of randomised clinical trials was conducted to assess whether lavender is anxiolytic [12]. The authors found eight trials investigating the effect of lavender oil inhalation of which four reported a significantly positive effect for at least one anxiety outcome measure. On the other hand a study examining the effectiveness of essential oils in reducing anxiety in patients awaiting the results of thoracic investigative and staging surgery, did not find a neroli/ sandalwood blend to be effective in reducing anxiety [13]. Inhaled bergamot was not found to be effective for reducing anxiety, nausea or pain in children and adolescents undergoing stem cell infusion [14], and the inhalation of lavender, bergamot and cedarwood administered concurrently with radiotherapy was not found to be effective in reducing anxiety [15]. However a continuous application of citrus fragrance for patients with depressive illness was found to bring about a significant reduction in depression [16]. 1.1. Description of aromastick use at this cancer centre Any patient seen by the complementary therapies team at our centre, for any reason, may be offered, or may request, an aromastick. Essential oils for the aromasticks are chosen by the patients themselves in conjunction with the attending complementary therapist. All essential oils listed on the hospital’s Essential Oil Policy (see Table 1) are available for use in the aromasticks. Advice from the complementary therapists is based on their previous clinical experience, documented effects of odour inhalation in the literature, patients’ odour preferences and patients’ positive reaction to oils used in massage treatments. Therapists also carry two pre-blended mixes for nausea. These are the two blends which were chosen most often and found to be useful in one of our previous audits [2] namely: peppermint, ginger and lavender; and eucalyptus and lemon.
Table 1 Essential oils on the hospital’s Essential Oil Policy, available for use in the aromasticks. Bergamot (FCF) (Citrus bergamia) Black pepper (Piper nigrum) Black spruce (Picea mariana) Cardamom (Elettaria cardamomum) Cedarwood (Cedrus atlantica; Cedrus deodora) Chamomile, Roman (Chamaemelum nobile) Citronella (Cymbopogon nardus) Clary Sage (Salvia sclarea) Clove bud (Syzygium aromaticum) Cypress (Cupressus sempervirens) Eucalyptus (Lemon) (Eucalyptus citriodora) Eucalyptus (Eucalyptus globulus) Frankincense (Boswellia carterii) Geranium (Pelargonium graveolens) Ginger (Zingiber officinalis) Grapefruit (Citrus paradisi) Howood (Cinnamomum camphora) Immortelle (Helichrysum italicum) Lavender (Lavandula angustifolia) Lavender, spike (Lavandula latifolia) Lemon (Citrus limon)
Lemongrass (Cymbopogon citratus) Lime (Citrus aurantifolia) Mandarin (Citrus reticulata) Mandarin petitgrain (Citrus reticulata L. Blanco) Manuka (Leptospermum scoparium) Marjoram (Origanum majorana) Mint bergamot (Mentha citrata) Myrtle (Myrtus communis) Neroli (Citrus aurantium) Niaouli (Melaleuca quinquenervia) Orange (Sweet) (Citrus sinensis) Patchouli (Pogostemon cablin) Plai (Zingiber cassumunar Roxb) Peppermint (Mentha x piperita) Petitgrain (Citrus aurantium) Rose otto (Rosa damascena) Rosemary (Rosmarinus officinalis) Sandalwood (Santalum album; Santalum austrocaladonicum) Spearmint (Mentha spicata) Tea tree (Melaleuca alternifolia) Ylang-ylang Extra (Cananga odorata)
The choice of oils on the Essential Oil Policy reflects. currently available scientific research. the professional judgement of the Clinical Lead for Complementary Therapies. past experience of patient needs. the practicality of safely storing and using a limited quantity of oils. the cost of the oils. This is not a definitive list of essential oils that may be used on people with cancer. It is updated annually to take account of changing circumstances.
3.1. Patient demographics Female patients 401 (78%). Male patients 113 (22%). 3.2. Tumour group The proportion of patients from different cancer tumour groups who received aromasticks was: Haemato-oncology 157 (31%). Breast 113 (22%). Gynaecology 86 (17%). Gastrointestinal 57 (11%). Neuro-oncology 25 (5%). All other diagnoses each less than 5%.
2. Methodology
3.3. Reasons for giving aromasticks
The audit plan was approved by the hospital clinical audit committee. Sample: All aromasticks given to patients between January 2011 and April 2013. The documentation of aromastick use includes patient’s gender, cancer diagnosis, the reason why the aromastick was given and which essential oils were used. The data reviewed was collected from the documentation.
On our documentation of aromastick use (the Aromastick Record) the complementary therapists are able to write why they have given the aromastick in their own words. When analysing the Aromastick Record, we grouped the reasons for aromastick use into 16 categories representing both symptoms to be attenuated (eg nausea) and desirable states to be encouraged (eg relaxation) (see Table 2). We considered the number of times aromasticks were given for each symptom category and whether or not male and female patients were given aromasticks for similar reasons (see Table 3). Nausea was the most common reason an aromastick was given. Aromasticks given to encourage relaxation, particularly for female patients, was the second highest reason an aromastick was given, followed by anxiety, well-being and sleep problems. Anxiety was
3. Results Over this 28 month period 514 aromasticks were given out to patients as detailed below. All percentages throughout are rounded to the nearest whole number.
Please cite this article in press as: Dyer J, et al., The use of aromasticks at a cancer centre: A retrospective audit, Complementary Therapies in Clinical Practice (2013), http://dx.doi.org/10.1016/j.ctcp.2013.11.006
J. Dyer et al. / Complementary Therapies in Clinical Practice xxx (2013) 1e4 Table 2 Categories of symptom for aromastick use in oncology patients.
Table 4 Essential oils used most often in aromasticks given to oncology patients by complementary therapists.
Category
Examples of category
Nausea Relaxation Anxiety Well-being
To relieve or prevent nausea To help increase relaxation, reduce stress For help with anxiety, panic attacks, needle phobia To increase well-being, comfort, patient liked the smell, support, pleasure For poor sleep, insomnia Uplifting for low mood, depression, tearfulness For patients feeling short of breath, chesty or with blocked sinuses Fatigue For poor appetite, to enhance appetite To distract from pain or using same blend as that used in massage for pain (positive odour association) Headache Hot flushes possibly as distraction or for calming To mask malodour For claustrophobia in the MRI scanner Distraction (eg from itch) Dizziness
Sleep Low mood Short of breath Fatigue Low appetite Pain Headache Hot flushes Malodour Claustrophobia Distraction Dizziness
the only category in which there appeared to be a difference in proportions of aromasticks given to male and female patients. 3.4. Essential oils used in aromasticks The essential oil used most often was lavender (Lavandula angustifolia). Essential oils from the citrus and mint families as well as frankincense, ginger and eucalyptus were also used frequently. In addition to the 17 most used essential oils listed in Table 4, a further 20 essential oils were each used less than 25 times (in less than 5% of aromasticks). Most of the aromastick blends in this audit were individual combinations of essential oils blended by the complementary therapists to suit the patients’ symptoms and preferences. Only the four blends listed in Table 5 were used ten or more times. 4. Discussion The essential oil we used most often was lavender (Lavandula angustifolia); this may be because of its widely acceptable and familiar odour. As can be seen in Table 3, nausea was the most common reason an aromastick was given. In a previous audit we had looked specifically Table 3 Aromasticks given by complementary therapists: frequency of each category and patient gender. Category
Nausea Relaxation Anxiety Well-being Sleep Low mood Short of breath Fatigue Low appetite Pain Headache Hot flushes Malodour Claustrophobia Distraction Dizziness Total
Patient’s gender Female
Male
Total
112 85 57 38 36 20 17 13 11 4 2 2 1 1 1 1 401
33 18 17 12 12 3 5 4 4 2 2
145 103 74 50 48 23 22 17 15 6 4 2 2 1 1 1 514
(28%) (21%) (14%) (9%) (9%) (5%) (4%) (3%) (3%) (1%) (
