Orange interventions for symptoms associated with dimethyl sulfoxide during stem cell reinfusions: a feasibility study.
Cancer Nursing. 2011 Sep-Oct;34(5):361-8.
Cancer Nursing. 2011 Sep-Oct;34(5):361-8.
The Study: This study took 60 patients over the age of 18 who were receiving at least two bags of autologous stem cell transplant cells. Each patient had never received a transplant before and was not allergic to oranges. Patients were randomly assigned to 1 of 3 groups: an orange intervention, and orange aromatherapy intervention, or control. Controls were offered treatment after the study was done. Non-symptomatic patients were not pre-medicated with anti-nausea medicine, but 11 symptomatic patients were given anti-nausea medication. Symptomatic improvement was measured through a 0 to 10 scale of tickle/cough urge, nausea, and retching. Relief scale, 0 to 10, was also measured.
The orange group was given an orange cut into quarters to sniff or taste. Orange aroma intervention patients were given oil in a sample to smell. Control patients took a couple of deep breaths. They were questioned as the first bag finished and the next bag was run. 19 patients were in the orange intervention, 23 in the aromatherapy intervention, and there were 18 controls.
Effects showed that symptom intensity was lowers in the orange intervention group, but it was not statistically significant. Vomiting occurring in 20% of patients, regardless of group. The orange intervention had significantly greater relief from intervention than the other groups. There was a weight-by-intervention interaction for the orange intervention group; the oranges were strongly effective in patients less than 90 kg but had no benefit in patients over 90 kg. The orange aromatherapy intervention caused an increase in heart rate in 28 beats/min, though always remained within normal clinical parameters during treatment.
Limitations: The study was small and was made primarily of educated white men. The study only looked at symptoms during the first two bags of infusion, potentially missing latent or late-onset nausea. Study participants may have had difficulty with the subjective measures of symptom intensity and symptom relief, two related but different measures.
What This Means: Orange interventions or aromatherapy can be effective in providing relief for patients undergoing stem cell transplant. However, these interventions may be more effective depending on a patient's characteristics, including weight. Oranges, which provide taste stimulation in addition to smell, may be an alternative to patients who do not have access to aromatherapy. However, aromatherapy may have physical effects, such as a increase in heart rate, that are not fully understood and need to be studied further.
My Take: This study showed took an interesting look at the stimulation of different senses for symptom relief. As the study showed, using orange slices instead of orange aromatherapy may be a more effective way to decrease symptom intensity and relief.
Aside from proving efficacy, I think the most important point in this study is its inexpensive and accessible use of CAM. For sites with little access to CAM practioners, purchasing an orange in the supermarket is an easy alternative to finding orange essential oil online (note: if you do use oil, make sure you use therapeutic grade!) For patients who are wary of CAM and words like "aromatherapy," using an orange offers similar relief but with an everyday object. This simple but fairly genius intervention upholds the classic public health principles of accessibility and affordability with a measurable effect.
However, the study left out a very important point of this care: how did the study address the one universal side effect of orange slices, sticky hands?
