The potential for the massage therapist to encounter a client in a stage of treatment for some form of cancer has grown in the last few decades. If you use essential oils in your massage practice, there are some things to consider.

Despite an idea being enthusiastically circulated by purveyors of essential oils, no essential oil is known to be a cure for cancer. Those promoting the essential oil of frankincense (Boswellia carteri) for its anti-cancer activity, especially those recommending it for topical and ingestion treatment to effect a cure, might be overlooking a fact about aromatherapy chemistry. Most of the actual research done on frankincense and cancer has involved promising active ingredients found in the resin. One of these is boswellic acid, a non-volatile, triterpene that does not exist once the resin is put through hydro-distillation to produce the essential oil.

For this, and other reasons, applying frankincense in massage will not create a miracle. It's also out of the scope of practice to prescribe a tea made with resin tears and that's also not advisable. Boswellia carteri is an endangered species with regulations imposed on production which results in scarcity. That creates a high probability of a resin adulterated by inclusions or substitution. And even if the absolute, 100% pure resin is available at an affordable cost, the studies undertaken do not convey the safe and appropriate dosage that might achieve in the body what has been seen in a petri dish.

As is frequently the case, there is little scientific research to report about the efficiency of aromatherapy for patients undergoing treatment for cancer. Most of the information we have comes from the empirical evidence of practicing aromatherapists and their clients.

I did find one study* that measured changes in patient-reported levels of physical or psychological distress or quality of life using essential oils and massage. The most observable effect was relief of anxiety. The study did not conclude that the addition of essential oils was necessary to achieve this. They reported that beneficial effects on other symptoms, such as depression and pain, may occur, but they concluded that more testing is necessary to make evaluations. I did not find any evidence of further research.

There have also been studies on the monoterpene content of essential oils relating to cancer prevention and treatment, particularly limonene.** But it is extremely important to understand that one isolated component used in vitro does not replicate the experience of topical use of the whole essential oil. This evidence would not support the idea that an aromatic massage with an essential oil containing limonene (such as lemon, Citrus limon) would produce a cure.

Having said this, can aromatherapy massage help cancer patients? Has that one study disproved the efficiency of essential oils in massage? I think not. And there are decades of empirical evidence that would agree with me. It's also helpful to know that empirical evidence is sometimes more useful than other forms of research. When scientific research is conducted on the use of essential oils in treatment of cancer patients, only a very few are selected for the trials. These are administered in a clinical setting, which can also affect the patient's response. What the educated aromatherapist knows is that the best way to use essential oils is in a holistic rather than symptom-specific approach. This is because essential oils have specific effects on physical, mental, emotional and spiritual levels. All essences that are known to reduce pain do not have the same specific effects on these subtle levels. Clinical trials do not generally address these differences.

One reason a test might include only a few essences is that, in the case of an institution such as a clinic or hospital, "efficiency" would require a one size fits all approach that would indicate one specific essential oil for each symptom. But there are underlying reasons why a person undergoing chemotherapy and radiation would have anxiety, reflecting the other life circumstances that need to be considered. The effective use of aromatherapy would include ascertaining these individual needs and using the corresponding essential oils that would address them. In a massage therapy practice, there is an opportunity to discover and to address all the client's life issues and create a specific blend that is likely to have very helpful results. Are there contraindications for using essential oils in massage for cancer patients?

It has long been believed that certain essential oils are not to be used during cancer treatment as they might inhibit or increase the uptake of chemotherapy ingredients. This idea has, for the most part, been disproven in the case of skin application. There is an in vitro study of the effect of the essential oil component geraniol*** (found in geranium and others) on cells of colon cancer that showed an increase in the uptake of 5-FU with geraniol present. In concluding statements: "By fluidizing the membrane, geraniol may favor cellular uptake of anticancer drugs. This could permit the use of lower concentrations of chemotherapeutic drugs and, at the same time, lower their secondary effects. Investigations are in progress with different colonic cancer models in rodents to determine whether the combination of geraniol and 5-FU may offer a promising approach for optimizing the treatment of colorectal cancer." However, this combination is not achieved during topical application or diffusion. And once again,the ratio and effect of a single component in the total chemistry of an essential oil is not the same as that used to measure this component in isolation.

On the matter of use with skin cancer, Robert Tisserand, renowned Aromatherapist and co-author of Essential Oil Safety, 2nd edition, had this to say in answer to a reader's question on his online blog via Robert Tisserand.com in 2012: "A number of essential oils enhance the transcutaneous penetration of other substances. This is a widely-studied phenomenon and research is ongoing. It happens because some essential oil constituents are very good at crossing the epidermis. In a 1991 paper, Williams and Barry found that 1,8-cineole, the major constituent of eucalyptus oil, enhanced the skin permeability of 5-FU by an incredible 95 times. 5-FU is only applied to the skin to treat skin cancers. In those situations, it would be prudent to avoid applying any essential oils or aromatherapy products to the same area of skin. When 5-FU is given intravenously (for internal tumors) applying essential oils to the skin will have no effect. Similarly, ingested essential oils will not affect the dermal delivery of 5-FU, or any other substance."

What the massage therapist can consider, then, is utilizing the empirical evidence that suggests certain essential oils for different phases, circumstances and emotions encountered during cancer treatment. Please consult a reference text for more information about each essential oil listed below. (Suggested texts appear at the end of this article.)

During Treatment

Shock: Neroli (orange blossom), rose otto, ylang ylang, clary sage, patchouli, petitgrain.

Anger: topical diluted and diffusion: roman and German chamomile, lavender, myrrh, mandarin.

Burns: (radiation): topical diluted: carrot seed, lavender, helichrysum.

Courage and Stamina: diffusion of all citrus, sweet orange, sweet basil, rosemary verbenone, thyme, cedar, ginger.

Depression: topical diluted and diffusion: lavender, geranium, rose otto, clary sage, roman chamomile, sweet orange, grapefruit, frankincense.

Insomnia: topical diluted and diffusion: lavender, roman chamomile, jasmine, sweet marjoram, sweet orange, neroli.

Malodorous Wounds: apply to external side of dressing: lemon, clove, lavender. Diffuse in room: pine, lemongrass, lemon, sweet orange.

Nausea: inhalation: peppermint, ginger, sweet fennel (as preferred by the client).

Wound (incision) Healing: topical diluted: lavender, geranium, myrrh, helichrysum, frankincense.

Opportunistic Infection Prevention: topical diluted and diffusion: lavender, tea tree, eucalyptus globulus.

Post treatment

Adrenal support: topical diluted and diffusion: rose geranium, sweet basil, pine.

Immune support: topical diluted and diffusion: ravensara, tea tree, lavender, spike lavender, thyme.

Lymphedema: topical diluted or compress: cypress, helichrysum, blue chamomile, yarrow, juniper berry.

I encourage the massage therapist to explore the use of essential oils for this client population. In this way, they can discover their own empirical evidence for using aromatherapy with clients diagnosed with cancer who have received the go-ahead from their physician for receiving massage therapy as part of their treatment protocol.

Suggested Reference Texts

1. The Aromatherapy Practitioner Manual, Vols I and II, Sylla Sheppard Hanger, Atlantic Institute of Aromatherapy publisher.
2. The Complete Guide to Aromatherapy, Salvatore Battaglia, second edition, The International Centre of Holistic Aromatherapy publisher.
3. Essential Oil Safety, 2nd edition, Robert Tisserand and Rodney Young, Churchill Livingstone publisher.

Referenced Research

*Aromatherapy and massage for symptom relief in patients with cancer. Fellowes D1, Barnes K, Wilkinson S. 2004, www.ncbi.nlm.nih.gov/pubmed/15106172.

** www.ncbi.nlm.nih.gov/pmc/articles/PMC1470060/

*** Geraniol, a Component of Plant Essential Oils, Sensitizes Human Colonic Cancer Cells to 5-Fluorouracil Treatment S. CARNESECCHI, K. LANGLEY, F. EXINGER, F. GOSSE, and F. RAUL, November 16, 2001 http://jpet.aspetjournals.org/content/301/2/625.full.pdf.