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Effect of aromatherapy with rose essential oil on
the nausea and vomiting in chemotherapy patients:
a randomized controlled trial
Poorya Takasi, MSca, Atefeh Ghanbari, PhDb, Saman Maroufizadeh, PhDc, Shirin Parvinroo, MDd,
Sirous Gharib, MDe, Tahere khaleghdoost Mohammadi, MScb,*, Sanam ashrafi,MD
f
Background: The present study aims to determine the effect of aromatherapy with rose essential oil on the rate of nausea and
vomiting in chemotherapy patients.
Materials and methods: This randomized controlled trial included 66 cancer patients who were randomly divided: the rose
essential oil aromatherapy group (n=33) and the control group (n=33). The sampling period ranged from November 2022 to March
2023. The state of nausea and vomiting was assessed using the Visual Analog Scale.
Results: The average scores of nausea and vomiting of both the second and third cycle in three time periods after chemotherapy
(first, second, and third six hours) were significantly lower in the intervention group than the control group (P<0.001). Also, in the
second cycle of chemotherapy, unlike the third cycle of chemotherapy, there was a significant interaction between group and time
(ηp2 =0.100, P=0.001, F (84.70, 1.37) =6.91). In other words, the amount of difference between the mean scores of nausea and
vomiting of the two control and intervention groups depended on the variable levels of time and vice versa.
Conclusion: The results indicate the reducing effect of aromatherapy with rose essential oil on the severity of nausea and vomiting
after chemotherapy in cancer patients. Therefore, it is recommended to be used in chemotherapy to reduce the severity of nausea
and vomiting according to the patient’s condition.
Keywords: aromatherapy, cancer patients, chemotherapy, essential oils, nausea
Introduction
The management of nausea and vomiting is crucial in supporting
the treatment of patients undergoing chemotherapy, as it can
impact treatment outcomes by potentially reducing the effec-
tiveness of the therapy. The intensity and duration of these
symptoms vary between individuals and may also be influenced
by the specific chemotherapy drugs administered
[1]
. The experi-
ence of nausea and vomiting after chemotherapy significantly
affects the quality of life for patients, who widely acknowledge
these side effects as common during cancer treatment. These
symptoms are particularly prevalent both before and after
chemotherapy, affecting ~10–30% of patients undergoing such
treatment
[2]
.
Despite significant progress in drug therapy aimed at control-
ling and minimizing nausea and vomiting in chemotherapy
patients, this remains a persistent issue. However, the regular and
continuous use of antinausea and vomiting medications may lead
to adverse effects like drowsiness, fatigue, reduced cognitive
abilities, headaches, and dry mouth
[3,4]
.
HIGHLIGHTS
•The average scores of nausea and vomiting of both the
second and third cycle in three time periods after che-
motherapy (first, second, and third six hours) were sig-
nificantly lower in the intervention group than the control
group (P<0.001).
•Also, in the second cycle of chemotherapy, unlike the third
cycle of chemotherapy, there was a significant interaction
between group and time (ηp2 =0.100, P=0.001, F (84.70,
1.37) =6.91).
•In other words, the amount of difference between the mean
scores of nausea and vomiting of the two control and
intervention groups depended on the variable levels of time
and vice versa.
•The results indicate the reducing effect of aromatherapy
with rose essential oil on the severity of nausea and
vomiting after chemotherapy in cancer patients.
•Therefore, it is recommended to be used in chemotherapy
to reduce the severity of nausea and vomiting according to
the patient’s condition.
a
Department of Medical-Surgical Nursing,
b
Department of Nursing, School of
Nursing and Midwifery,
c
Department of Biostatistics and Epidemiology, School of
Health,
d
Department of Pharmacognosy, School of Pharmacy,
e
Department of
Hematology and Oncology, School of Medicine and
f
Razi Hospital, Guilan University
of Medical Sciences, Rasht, Iran
Sponsorships or competing interests that may be relevant to content are disclosed at
the end of this article.
Published online 16 November 2023
*Corresponding author. Address: Department of Nursing, School of Nursing and
Midwifery, Guilan University of Medical Sciences, Rasht 41469-39841, Iran.
Tel.: +98 9111351245; +98 13-33552088; fax: +98 13-33550097;
E-mail: khaleghdoost@gums.ac.ir (T.K. Mohammadi).
Received 21 August 2023; Accepted 3 October 2023
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. This is an
open access article distributed under the terms of the Creative Commons
Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to
download, share, remix, transform, and buildup the work provided it is properly cited.
The work cannot be used commercially without permission from the journal.
Annals of Medicine & Surgery (2024) 86:225–231
http://dx.doi.org/10.1097/MS9.0000000000001395
’
Randomised Controlled Trial
225
Presently, there is a growing interest in complementary medi-
cine, particularly the use of medicinal plants, as a means to
address the complications and symptoms associated with diverse
diseases. This approach offers cancer patients the opportunity to
manage their health challenges with medications that often have
fewer side effects and are more cost-effective
[5]
.
Aromatherapy, a time-honored method in complementary
medicine with a history spanning thousands of years, involves
using extracts derived from various parts of plants, such as
flowers, leaves, and stems, for diverse treatments. Volatile
essential oils are utilized in aromatherapy through inhalation,
oral administration, and topical application
[6,7]
. The effectiveness
of aromatherapy manifests in multiple ways, with inhalation
being the swiftest method of absorption. Inhaling essential oils in
aromatherapy can positively impact mental, physical, and emo-
tional well-being
[8,9]
. Moreover, there is a wide range of oils and
essential oils available for use in aromatherapy
[10]
.
Rose with scientificnameofRosa demascena Mill can serve as a
complementaryremedyandaidinalleviatingnauseaandvomiting
through aromatherapy
[11]
. This plant contains a diverse range of
compounds, including terpenes, tannins, glycosides, flavonoids,
anthocyanins, carboxylic acid, vitamin C, kaempferol, and
geraniol
[12]
. When the essential oil is inhaled, its aromatic volatile
particles travel to the nostrils. Within the nose, the hairs and villi act
as receptors, transmitting electrochemical signals to the emotional
and memory centers. This stimulation then spreads throughout the
body via the bloodstream, resulting in the production of the scent’s
reaction
[13]
. A German research study demonstrated the effectiveness
of rose scent in reducing complications associated with motion
sickness, with nausea being one of the significant risks
[14]
. Similarly, a
separate study conducted in Turkey investigated the effects of
aromatherapy using ginger, lavender, rose, and placebo on post-
operative nausea and vomiting. The findings revealed that aro-
matherapy could serve as an alternative or complementary approach
to managing postoperative nausea and vomiting
[15]
.
In modern nursing care, complementary medicine is becoming
increasingly popular among nurses when attending to patients. The
appeal lies in its economic affordability, minimal side effects com-
pared to conventional drugs, and the fact that it does not require
specialized equipment
[10]
. Notably, studies have demonstrated the
beneficial impact of rose essential oil on nausea and vomiting in
various scenarios like motion sickness, gastric reflux, and post-
operative nausea and vomiting. However, there is a notable gap in
research concerning its effect on nausea and vomiting in patients
undergoing chemotherapy. Hence, this study aims to explore the
potential of aromatherapy with rose essential oil as a means to
alleviate chemotherapy-induced nausea and vomiting, calling for
further investigation in this area.
Methods
Study design
A randomized controlled trial was carried out in North of Iran,
aiming to explore the impact of aromatherapy using rose essential
oil on the frequency of nausea and vomiting among patients
undergoing chemotherapy in line with CONSORT criteria
[16]
(Fig. 1).
Ethics consideration
This study was registered in the Iranian Registery of clinical Trials
and received ethical approval from the Ethics Committee of
Figure 1. Flow diagram of participants.
Taksi et al. Annals of Medicine & Surgery (2024) Annals of Medicine & Surgery
226
Guilan University of Medical Sciences. All participants provided
informed consent after being thoroughly briefed on the objectives
of the study. They were explicitly informed that they had the right
to withdraw from the study at any point if they wished to do so.
Participants
The study’s participants consist of individuals who are currently
undergoing chemotherapy. The sampling period ranged from
November 2022 to March 2023. The research comprised 66
cancer patients who were randomly allocated into two groups:
the control group and the intervention group. After screening and
selecting patients who met the study’s criteria, they were assigned
to either the intervention group or the control group using block
randomization. The block randomization method utilized blocks
of size 4 and 6 in equal proportions (ratio 1:1) to allocate 33
participants to each group. The study’s inclusion criteria were as
follows: participants had to be 18 years or older, have undergone
at least one cycle of chemotherapy, based on the results of
paraclinical tests in the patient’sfile and doctor’s examination, be
free of hepatitis, brain malignancies, brain metastases, and other
metastases, not have allergies to herbal medicines and aromatic
essences, possess a normal sense of smell, be able to communicate
in Farsi, and be receiving chemotherapy drugs known for their
high potential to cause nausea and vomiting. Participants were
excluded from the study if they demonstrated noncooperation
with the research team or expressed a desire to withdraw from the
study during the research period. Additionally, individuals
experiencing any allergic reactions due to aromatherapy, sudden
fluctuations in hemodynamic status, or those who passed away
during the study were also excluded.
Sample size
To compare the average scores of nausea and vomiting in patients
undergoing chemotherapy between the aromatherapy group
using rose essence and the control group, the sample size was
determined using the following formula:
()
=
+
+
αβ α
−/ − −/
n
zz
d
z
2
4
12 1
2
2
12
2
The sample size was determined with a consideration of a type
I error of 0.05 and a type II error (power) of 0.8. The researcher
anticipated a practical difference with an effect size value of
d=0.8 (large). Using the formula, it was calculated that 26 par-
ticipants were needed in each group. Accounting for a potential
20% loss, the final sample size for each group was set at 33
people, resulting in a total sample size of 66 individuals.
However, two patients chose to withdraw from the study during
the third cycle of chemotherapy due to their unwillingness to
continue with aromatherapy. As a result, 64 patients remained in
the study. The data collection process is illustrated in Figure 1,
which presents the flow diagram of the participants.
Intervention
Before the intervention, all patients provided written consent
after receiving detailed explanations regarding the study’s pur-
pose and methodology. Demographic information was collected
through patient interviews and documented accordingly. The
level of nausea and vomiting in both the control and
aromatherapy groups was assessed using the visual analog scale
(VAS) 1 h before chemotherapy. In case there were any uncer-
tainties or ambiguities in the questionnaire, the researcher offered
additional explanations to ensure accurate answers. To ascertain
that the participants were not sensitive to rose essential oil, a skin,
and respiratory test was conducted on all patients in the inter-
vention group. A drop of rose essential oil, with a concentration
of 40%, was applied to the inner surface of the patient’s wrist,
and a dressing was applied. After 2 min of skin contact, the wrist
area was observed for any reactions. Additionally, a sample of the
oil was placed on gauze near the patient’s nose to check for any
signs of headaches. Only individuals who did not exhibit allergy-
based symptoms (such as redness, hives, itching, etc.) and did not
experience headaches were included in the study.
In the intervention group, the assessment of nausea and
vomiting occurred once every hour before chemotherapy. During
the chemotherapy session, 5 min before its commencement, three
drops of rose essential oil (40% concentration) were applied to a
sterile gauze measuring 5 ×5. The gauze was then attached to the
patient’s collar using a safety pin, ensuring that it was positioned
20 cm away from the patient’s nose. The reason for choosing this
method was the constant presence of the essential oil with the
patient so that there is no restriction on activity and movement.
The patients were instructed to breathe normally for 3 min before
each chemotherapy cycle, repeating this process for every session.
The data collection for this study was conducted over two cycles
of chemotherapy, with a 21-day interval between them. As the
patients spent a brief time at the clinic after chemotherapy and
then returned home, they were educated on attaching the gauze to
their clothing collars to manage nausea and vomiting for up to
18 h after treatment. Since the patients typically left the clinic
following the end of chemotherapy, the assessment of nausea and
vomiting was carried out via phone calls at three six-hour inter-
vals after chemotherapy, covering the 18 h postchemotherapy
period. Also, in addition to the intervention, standard antiemetic
care was also provided for the patients. In this way, granisetron
3 mg/3 ml and dexamethasone 8 mg/2 ml were injected before
starting chemotherapy. In addition, three capsules of aprepitant
were prescribed for the patients, and the patient took 125 mg
capsules on the first day and 80 mg capsules on the second and
third days.
Patient information was gathered through a questionnaire
covering demographic variables such as age, sex, marital status,
place of residence, employment status, level of education, family
history of disease, and any underlying medical conditions.
Additionally, the state of nausea and vomiting was assessed using
the VAS. The VAS was initially introduced by Clark and Spear in
1972, and it utilizes a score ranging from 0 to 10. A score of 0
indicates the absence of nausea and vomiting, while scores 1–3
represent mild nausea and vomiting, scores 4–6 indicate moder-
ate levels, scores 7–9 correspond to severe nausea, and a score of
10 indicates very severe nausea
[17]
. The VAS is a widely accepted
and standardized tool, and its validity and reliability have been
verified
[18]
.
Blinding
No placebo intervention was applied due to characteristic odor of
rose essential oil. Therefore, blinding of researchers and patients
to study groups could not be achieved.
Taksi et al. Annals of Medicine & Surgery (2024)
227
Statistical analysis
Data analysis was performed using SPSS software (version
16.0, SPSS Inc.). Descriptive statistics, including means (SD) for
continuous variables and frequencies (percentages) for catego-
rical variables, were reported. To compare qualitative demo-
graphic variables, both the χ
2
test and Fisher’s exact test were
employed. Also, quantitative demographic variables were com-
pared using the independent t-test. To explore the main effects of
group and time, as well as the interaction effect of group-time on
nausea and vomiting scores, repeated measures analysis of var-
iance was utilized. Specifically, the significance of the group-time
interaction effect during the second cycle was examined through a
simple main effects test. For this purpose, the mean scores of
nausea and vomiting between the control and intervention
groups were compared for each period using independent t-tests.
Moreover, the mean scores of nausea and vomiting were com-
pared separately for each period within the control and inter-
vention groups using repeated measures analysis of variance.
Effect sizes were also reported, including partial eta-squared
for repeated measures analysis of variance and Cohen’s d for
independent t-tests. A significance level of 0.05 was used for
determining statistical significance.
Results
Participants
As shown in Table 1, the study included 64 patients who were
undergoing chemotherapy, with 33 assigned to the control group
and 31 to the intervention group. The participants in the study
had an average age of 52.81 (SD =8.07). Among them, 60.9%
were female, and 98.4% were married. Additionally, 60.9% of
the participants had nonacademic education, and 48.4% were
housewives. Of the participants, 67.2% had a family history of
cancer, 62.5% had hypertension, 37.5% had diabetes, and
48.4% had hyperlipidemia. Additionally, 48.4% of the partici-
pants had colon cancer, and in 89.1% of them, the cancer was
classified as stage II. The chemotherapy regimen used in 46.9% of
the participants consisted of Oxaliplatin (135 mg), Leucovorin
(600 mg), Irinotecan (250 mg), and Fluorouracil (4000 mg).
There was no significant difference in demographic and clinical
characteristics between the control and intervention groups
(P>0.05).
Nausea and vomiting in patients undergoing chemotherapy
According to the assessment based on VAS before chemotherapy
on patients in both control and intervention groups, none of the
patients showed symptoms of nausea and vomiting.
As shown in Table 2, in all three time periods of the second
cycle, the intervention group exhibited lower levels of nausea and
vomiting compared to the control group. A significant interaction
between group and time (F =6.91, η
p2
=0.100, P=0.001) was
observed. This indicates that the disparity in average nausea and
vomiting scores between the control and aromatherapy groups is
influenced by the varying levels of time, and conversely, the effect
of time on the scores depends on the group assignment.
Significant differences were found between the aromatherapy
group using rose essential oil and the control group in the first six
hours after chemotherapy regarding average nausea and vomit-
ing scores (t=10.20, d=2.530, P<0.001). This trend persisted
in the second six hours (t=15.60, d=3.871, P<0.001) and the
third six hours after chemotherapy (t=13.56, d=3.404, P<
0.00). Cohen’s d-effect size values for these time intervals were
considerable, measuring 2.530, 3.871, and 3.404, respectively.
Based on the findings, the control group showed a statistically
significant difference in average nausea and vomiting scores
Table 1
Individual and clinical characteristics of the participants (N=64)
Groups
Total
(N=64)
Control
(N=33)
Intervention
(N=31) P
Individual characteristics
Age 52.81
(SD =8.07)
53.03
(SD =8.03)
52.58
(SD =8.25)
0.872*
Sex
Male 25 (39.1) 15 (45.5) 10 (32.3) 0.280**
Female 39 (60.9) 18 (54.5) 21 (67.7)
Marital status
Single 1 (1.6) 0 (0) 1 (3.2) 0.484***
Married 63 (98.4) 33 (100) 30 (96.8)
Level of education
Nonacademic 39 (60.9) 22 (66.7) 17 (54.8) 0.332**
Academic 25 (39.1) 11 (33.3) 14 (45.2)
Job
Housewife 31 (48.4) 15 (45.5) 16 (51.6) 0.264***
Self-employed 18 (28.1) 12 (36.4) 6 (19.4)
Employee 7 (10.9) 4 (12.1) 3 (9.7)
Retired 8 (12.5) 2 (6.1) 6 (19.4)
Clinical characteristics
Cancer history in the family
Yes 43 (67.2) 21 (63.6) 22 (71.0) 0.532**
No 21 (32.8) 12 (36.4) 9 (29.0)
Hypertension
Yes 40 (62.5) 22 (66.7) 18 (58.1) 0.477**
No 24 (37.5) 11 (33.3) 13 (41.9)
Diabetes
Yes 24 (37.5) 16 (48.5) 8 (25.8) 0.061**
No 40 (62.5) 17 (51.5) 23 (74.2)
Hyperlipidemia
Yes 31 (48.4) 14 (42.4) 14 (45.2) 0.321**
No 33 (51.6) 19 (57.6) 17 (54.8)
Type of cancer
Breast 28 (43.8) 13 (39.4) 15 (48.4) 0.745**
Colon 31 (48.4) 17 (51.5) 14 (45.2)
Stomach 5 (7.8) 3 (9.1) 2 (6.5)
Stage of cancer
II 57 (89.1) 29 (87.9) 28 (90.3) 0.754**
III 7 (10.9) 4 (12.1) 3 (9.7)
Type of chemotherapy drugs
Endoxan (1000 mg) -
Adriamycin (100 mg)
29 (45.3) 14 (42.4) 15 (48.4) 0.858**
Oxaliplatin (135 mg) -
Leucovarin (600 mg) -
Irinotecan (250 mg) -
Fluorouracil
(4000 mg)
30 (46.9) 16 (48.5) 14 (45.2)
Taxotere (80 mg) -
Oxaliplatin (80 mg) -
Leukovarin (400 mg) -
Fluorouracil
(3000 mg)
5 (7.8) 3 (9.1) 2 (6.5)
Values are given as a mean (SD) for continuous variables and a number (percentage) for categorical
variables.
*P-value was obtained with an independent t-test.
**P-value was obtained with a χ
2
test.
***P-value was obtained with a Fisher exact test.
Taksi et al. Annals of Medicine & Surgery (2024) Annals of Medicine & Surgery
228
across different time points (F =194.47, η
p2
=0.859, P<0.001).
Specifically, the mean scores of nausea and vomiting in the second
six hours after chemotherapy were significantly higher than those
in the first six hours and the third six hours after chemotherapy
(P<0.001). Additionally, the mean scores of nausea and vomit-
ing in the third six hours were significantly higher than those in
the first six hours (P<0.001). According to the findings, the
aromatherapy group using rose essence exhibited a statistically
significant difference in average nausea and vomiting scores
across different time points (F =194.44, η
p2
=0.849, P<0.001).
Specifically, the mean scores of nausea and vomiting in the second
six hours after chemotherapy were significantly higher than those
in the first six hours and the third six hours after chemotherapy
(P<0.001). Additionally, the mean scores of nausea and vomit-
ing in the third six hours were significantly higher than those in
the first six hours (P=0.002).
As shown in Table 3, throughout the third cycle, the inter-
vention group consistently demonstrated lower mean values for
nausea and vomiting compared to the control group at all three-
time points. The absence of a significant interaction between
group and time (F =1.57, η
p2
=0.025, P=0.217) indicates that
the impact of the intervention did not differ significantly across
various time points. Nevertheless, the effect of time itself was
found to be significant (F =215.82, η
p2
=0.777, P<0.001).
This means that both studied groups exhibited a statistically
significant difference in the average scores of nausea and vomiting
at different time points, irrespective of the specific intervention.
Based on the two-by-two comparisons, the mean scores of nausea
and vomiting during the second six hours after chemotherapy
were significantly higher than those during the first six hours and
the third six hours after chemotherapy (P<0.001). However,
there was no statistically significant difference between the
average scores of nausea and vomiting during the first six hours
and the third six hours after chemotherapy (P=0.650).
Furthermore, the group effect was found to be significant
(F =291.69, η
p2
=0.825, P<0.001). This indicates that, across
all time points, the average scores of nausea and vomiting in the
aromatherapy group using rose essential oil were significantly
lower than in the control group. The effect size for the group
variable was large, highlighting the substantial impact of the
aromatherapy intervention on reducing nausea and vomiting.
Discussion
In this study, the impact of rose essential oil aromatherapy on
nausea and vomiting in cancer patients undergoing chemotherapy
was examined. The findings indicated a significant decrease in
postchemotherapy nausea among patients treated with rose essen-
tial oil aromatherapy, as compared to the control group. The study
conducted by Sriningsih and Lestari
[1]
titled ʽAromatherapy with
ginger for managing nausea and vomiting in chemotherapy among
cervical cancer patientsʼproduced outcomes that were consistent
with the findings of the current research.
The study’sfindings indicated that the variation in average nausea
and vomiting scores between the control and aromatherapy groups
using rose oil was influenced by different time intervals. Similarly, the
relationship worked both ways, withthetimeintervalsalsobeing
affected by the differences between the two groups. Notably, the
discrepancies between the control and aromatherapy groups differed
during the first six hours, second six hours, and third six hours,
highlighting the dynamic nature of the interaction. In their study
entitled ʽEffect of mint extract on the severity of nausea, vomiting,
and anorexia in breast cancer patients undergoing chemotherapyʼas
in the current study, Jafarimanesh et al.
[19]
showed that there is a
significant interaction between group and time, which means that in
24 h and 48 h after chemotherapy, the difference between the two
control and test groups is different, and on the contrary, the time
trend is dependent on the group, that is, the increasing and decreasing
trend in the control group is different from the intervention group.
The findings of this study revealed that during the second cycle
of chemotherapy, the aromatherapy group using rose essence
exhibited significantly lower average scores of nausea and vomiting
compared to the control group in the first six hours, second six
hours, and third six hours after the treatment. Similarly, in Tohidi
et al.‘s study titled ʽComparison of aromatherapy with lavender
and rose essential oil on the rate of nausea in chemotherapy
patientsʼ, comparable results were obtained. They observed a
statistically significant difference in terms of nausea between the
patients in the aromatherapy group with rose essential oil and the
control group at three-time points: the first, second, and third day
after chemotherapy. At these specifictimepoints,theaverage
nausea scores in the aromatherapy group were notably lower than
those in the control group
[20]
.
The current study’sfindings revealed significant differences in the
average scores of nausea and vomiting at different time points
Table 2
Nausea and vomiting in patients undergoing chemotherapy in both
control and aromatherapy groups with rose essence in the second
cycle (N=64).
Groups
Control
(N=33)
Intervention
(N=31) tP
The first six hours after
chemotherapy (T1)
2.33 (SD =0.60) 0.68 (SD =0.70) 10.20 <0.001*
The second six hours after
chemotherapy (T1)
4.21 (SD =0.55) 2.10 (SD =0.54) 15.60 <0.001*
The third six hours after
chemotherapy (T1)
3.03 (SD =0.64) 1.06 (SD =0.51) 13.57 <0.001*
F 194.44 168.09
P<0.001** <0.001**
Values are given as a mean for continuous variables.
*Pwas obtained with an independent t-test.
**Pwas obtained with a repeated measure ANOVA test.
Table 3
Nausea and vomiting in patients undergoing chemotherapy in both
control and aromatherapy groups with rose essence in the third
cycle (N=64).
Groups
Control (N=33) Intervention (N=31)
The first six hours after chemotherapy (T1) 3.58 (SD =0.66) 1.71 (SD =0.64)
The second six hours after
chemotherapy (T1)
5.12 (SD =0.42) 3.00 (SD =0.63)
The third six hours after
chemotherapy (T1)
3.73 (SD =0.57) 1.56 (SD =0.61)
Values are given as a mean for continuous variables.
Taksi et al. Annals of Medicine & Surgery (2024)
229
during the second cycle for both the control group and the aro-
matherapy group with rose essence. In the control group, the
average scores of nausea and vomiting were notably higher in the
second six hours after chemotherapy compared to the first six hours
and the third six hours. Additionally, during the third six hours, the
mean scores of nausea and vomiting were significantly higher than
those during the first six hours. Similarly, in the aromatherapy
group with rose essence, the average scores of nausea and vomiting
in the second six hours after chemotherapy were significantly higher
than in the first six hours and the third six hours. The mean scores of
nausea and vomiting in the third six hours were also significantly
higher than in the first six hours. Zorba et al. conducted a study
titled ʽInvestigation of the effects of massage and inhalation aro-
matherapy on chemotherapy-induced nausea and vomitingʼ.They
found that in the control group during the second cycle, there was a
significant difference in the average levels of nausea and vomiting in
the periods following chemotherapy. Specifically, the average scores
of nausea were higher in the second and third six hours compared to
the first six hours. However, unlike the present study, there was no
difference in the mean nausea scores during the third six hours. In
contrast, the aromatherapy groupshowedsimilarresultstoour
study, with the average scores of nausea in the second six hours
being higher than in the first six hours and the third six hours
[21]
.
In the present study, it was observed that the mean and stan-
dard deviation of nausea and vomiting scores in patients under-
going chemotherapy during the third cycle were lower in all three
time periods in the intervention group compared to the control
group. Afiat et al. conducted a study titled ʽComparison of the
effect of inhalation aromatherapy with rose gold and metoclo-
pramide on anxiety and depression of women with nausea and
vomiting during pregnancyʼ. They reported that after 5 days of
intervention, the nausea and vomiting levels in the aromatherapy
group with placebo were comparable to the control group. On
the other hand, the group that received aromatherapy with
metoclopramide showed a decreasing trend in the severity of
nausea and vomiting. These findings are consistent with the
results of our current study, suggesting that aromatherapy with
rose essential oil may be effective in reducing the intensity of
nausea and vomiting
[22]
.
In the present investigation, no significant interaction between
group and time was observed during the third cycle of che-
motherapy. This indicates that the time trend of nausea and
vomiting was not dependent on the group, meaning the decreasing
trend in the control group was similar to the aromatherapy group.
However, the effect of time was significant in both groups in the
third cycle, showing a statistically significant difference in average
nausea and vomiting scores at different time points. Specifically, the
average scores of nausea and vomiting in the second six hours after
chemotherapy were significantly higher than those in the first six
hours and the third six hours. However, there was no statistically
significant difference between the average scores of nausea and
vomiting in the first six hours and the third six hours after che-
motherapy. Additionally, the group effect was significant, indicat-
ing that at all time points, the average scores of nausea and
vomiting in the aromatherapy group with rose essential oil were
significantly lower than in the control group. In the study con-
ducted by Shirzad et al. titled ʽComparison of the effect of two
methods of rosehip aromatherapy and Benson’srelaxationon
preoperative anxiety, hemodynamics, and complications after nose
surgeryʼ, they found that in both the rose aromatherapy group and
Benson’s relaxation group, none of the subjects reported
experiencing nausea and vomiting after surgery. This finding sup-
ports the results of the present study, suggesting that aromatherapy
with rose essential oil, as well as in the intervention group of our
study, had a positive effect on reducing or eliminating nausea and
vomiting during specific time intervals after the intervention
[23]
.
Limitations
This study has two notable limitations. Firstly, the sampling was
conducted from a single clinic, which may limit the general-
izability of the findings to a broader population. Secondly, par-
ticipants in the aromatherapy group might experience a placebo
effect, as their perception of improvement could be influenced by
their belief in the effectiveness of the aromatherapy intervention.
Recommendations for future research
Given the significanceoftheresearchtopicandthescarcityofprior
studies on the impact of aromatherapy with rose essential oil on
chemotherapy-induced nausea and vomiting, the current study’s
findings can serve as a pivotal starting point and inspiration for
future research. Therefore, it is recommended that forthcoming stu-
dies explore the effects of rose essential oil aromatherapy on nausea
and vomiting in postchemotherapy cancer patients with larger and
more diverse populations. Additionally, future investigations should
take into account other potential factors that may influence nausea
and vomiting in cancer patients after chemotherapy.
Conclusions
In total, the study’sresultsrevealedasignificant reduction in
postchemotherapy nausea for patients treated with rose essential oil
aromatherapy compared to the control group. Based on the study’s
findings, it is suggested that health managers and policymakers in
the healthcare sector take steps to offer appropriate educational
opportunities for nursing personnel. This would aim to enhance
their understanding of the advantages of nonpharmacological
treatments and introduce them to various complementary medicine
methods, such as aromatherapy. Consequently, if patients admitted
to medical centers show interest in using aromatherapy, it should be
integrated into nursing care as a viable approach to effectively
alleviate nausea and vomiting.
Ethical approval
This study was registered in the Iranian Registery of clinical Trials
and received ethical approval from the Ethics Committee of
Guilan University of Medical Sciences. All participants provided
informed consent after being thoroughly briefed on the objectives
of the study. They were explicitly informed that they had the right
to withdraw from the study at any point if they wished to do so.
Consent
Written informed consent was obtained from the patient for
publication and any accompanying images. A copy of the written
consent is available for review by the Editor-in-Chief of this
journal on request.
Taksi et al. Annals of Medicine & Surgery (2024) Annals of Medicine & Surgery
230
Sources of funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
Author contribution
All authors contributed in study concept and design, data
acquisition, data interpretation, drafting the manuscript, revision
of the manuscript, and the final version of the manuscript.
Conflicts of interest disclosure
The authors declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Research registration unique identifying number
(UIN)
We could not register our manuscript in the Research Registry
UIN: www.researchregistry.com due to internet access restric-
tions and international sanctions. We live in Iran. We hardly even
meet the basic needs of our daily life. We do not receive any
funding for our research and we cannot pay for our research.
Please excuse us from registering this manuscript in the
Research Registry UIN: www.researchregistry.com. Also, this
study was registered in the Iranian Registry of clinical Trials
(IRCT20100921004787N7). https://en.irct.ir/user/trial/65005/
view Trial Id: 65005.
Guarantor
Tahere khaleghdoost Mohammadi.
Data availability statement
The datasets generated and analyzed during the current study are
available from the corresponding author on reasonable request.
Provenance and peer review
Not commissioned, externally peer reviewed.
Acknowledgements
The authors are grateful to all the participants in this study,
Shamime Shafa ramesh company and the staff of Beesat Rasht
Subspecialty Clinic.
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