INTRODUCTION

Chemotherapy is one of the most important parts of cancer treatment. Nausea and vomiting are the most common side effects of chemotherapy, accounting for 40-80% of all cases. Some studies have indicated that 50-70% of cancer patients experience nausea and vomiting during chemotherapy. Currently, various drugs are used to control nausea and vomiting caused by chemotherapy, which also have disadvantages and cause complications in addition to their advantages. Today, aromatherapy, as a traditional method of complementary and non-pharmacological medicine, is extensively used to help manage treatment complications in many patients. Aromatherapy is used both topically and inhaled. Rose essential oil is widely used in the perfumery and cosmetics industries as a base ingredient and in the food industry as a flavoring agent. The main producers of this plant are Turkey, Bulgaria, Iran, and India. The damask rose is native to Iran and is one of the 308 species of the rose family. This plant contains various vitamins, such as B1, B3, C, A, and K, as well as major substances, including Citric Acid, Pectin, Flavonoids, Geraniol, Citronellol, etc. In line with the mechanism explained above, citronellol reduces nausea and vomiting by activating the parasympathetic nervous system, and geraniol can help reduce nausea with its sedative and antispasmodic effects. In this regard, the results of a study indicated that aromatherapy with cardamom reduced the severity of chemotherapy-induced nausea in cancer patients. Another study reported that aromatherapy was not effective in the reduction of chemotherapy-induced nausea in children. The results of studies on the effect of aromatherapy are somewhat contradictory. However, importantly, aromatherapy is a cheap, non-invasive treatment with considerably fewer side effects, especially compared to standard medications. Despite numerous studies in the field of aromatherapy, the effect of rose essential oil on chemotherapy-induced nausea and vomiting has not been thoroughly investigated. Understanding the effect of this method can help improve the quality of care and reduce side effects. Therefore, the present study was designed to investigate the effect of aromatherapy with rose essential oil on chemotherapy-induced nausea and vomiting in women with cancer.
METHODS
This randomized clinical trial was conducted three times a day for every 76 patients undergoing chemotherapy at Ayatollah Khansari Hospital, Arak, Iran, in 2020. The patients were allocated into intervention (n=38) and control (n=38) groups. The intervention was implemented in this way after obtaining written consent from clients willing to participate in the study, with three sessions (morning, afternoon, and evening) for each patient, according to random codes, 15 minutes before the start of chemotherapy. The Rhodes questionnaire and 10 cm Visual Analogue Scale (VAS) were completed, and the demographic information questionnaire was completed by asking the patients questions and by the researcher observing the file. Then, a package containing a 20 ml dropper container (distilled water or rose essential oil with a purity of 40% purchased from Iran Teb Company), three pads with dimensions 10×10 cm, and a pin was given to the patients participating in the study. In the intervention and control groups, in addition to the standard medications prescribed by the attending physician, each patient was given a prepared package, and they were taught that after completing their chemotherapy, they should take six drops of the contents of the container containing rose essential oil with a purity of 40% for the intervention group and distilled water for the control group. Rose essential oil pour onto the pads using a dropper and pin each pad given for each session before each main meal within 24 hours (morning, noon, night) at a distance of 30 cm from the nose to the collar of their clothes and inhale the contents of the pad for 20 minutes with a normal breathing pattern. Immediately after inhalation, the pad used in that session should be discarded and a new one used in the next session. Next, the VAS questionnaire and the number of vomiting and belching episodes were used to assess nausea severity 24 hours after chemotherapy. The Rhodes questionnaire and VAS were completed by the researcher over the phone 24 hours after chemotherapy was completed and after the use of the packages given to the research participants. Data were analyzed using the SPSS (version 26) software.
RESULTS
The results demonstrated that the mean age of the patients was 43.01±8.74 years in the range of (27-66) years. The results indicated that the mean age of the patients in the two groups did not have a statistically significant difference. The groups showed no significant differences in demographic characteristics (marital status, occupation, education level, alcohol consumption, or motion sickness). Post-intervention, the mean nausea intensity was significantly higher in the control group (3.76±1.53) compared to the intervention group (2.63±1.73; P=0.003). The mean vomiting frequency was higher in the control group (0.210±0.52) than in the intervention group (0.026±0.16; P=0.043). Similarly, mean retching frequency indicated significant differences between control (0.97±0.75) and intervention groups (0.5±0.86; P=0.013).
CONCLUSION
Rose essential oil aromatherapy was able to significantly reduce both the severity and frequency of gastrointestinal symptoms compared to the control group. The main advantages of this intervention are its high safety, ease of use, low cost, and lack of interference with standard treatments. Given that nausea and vomiting are common and debilitating side effects of chemotherapy, the use of this method can probably improve the quality of life of patients during the treatment period. This method is recommended as part of a comprehensive care plan for patients undergoing chemotherapy. The current work faced limitations, including a lack of complete control over confounding variables.
Keywords: Breast cancer, Chemotherapy, Nausea, Rose essential oil, Vomiting
Ethical Considerations
Compliance with ethical guidelines
This work is the result of a master's thesis in Medical-Surgical nursing with the ethics code IR.ARAKMU.REC.1400.199 and registered in the Iranian Trial with the code IRCT20211117053090N1.
Funding
This research was conducted with financial support from the Arak University of Medical Sciences, Iran.
Authors’ Contribution
The authors contributed equally to the conceptualization and writing of the article. All of the authors approved the content of the manuscript and agreed on all aspects of the work
Conflict of Interest
The authors declared that there is no conflict of interest.
Acknowledgments
We would like to express our sincere gratitude to all the patients participating in this study who made this research possible with their patience and support, as well as to the officials of Ayatollah Khansari Hospital and the Vice President for Research of Arak University of Medical Sciences, Iran, who provided the necessary cooperation in carrying out this research. In addition, we are grateful to all the individuals who provided scientific consulting for this work.