Background:

Bone marrow aspiration and biopsy (BMAB) is an important procedure for those diagnosed with hematologic conditions but often provokes anxiety and pain. These symptoms are commonly treated with opioids and benzodiazepines, which may cause adverse events such as nausea, dizziness, or impaired coordination. Previous research on the effects of lavender aromatherapy on peri-procedural anxiety and pain management has provided promising results. Linalool, the main active component of lavender, has been shown to have anxiolytic effects in animal models after inhalation however, no prior studies have evaluated linalool aromatherapy in BMAB settings. This randomized, single-blind, placebo-controlled pilot study investigates the feasibility and preliminary efficacy of lavender or linalool aromatherapy versus placebo (jojoba oil) for reducing anxiety and pain during BMAB.

Methods:

Eligible adult patients (n = 45 planned) scheduled for BMAB at City of Hope were screened for medical history and baseline anxiety. Inclusion criteria required a pre-procedural anxiety score >3/10 on the Visual Analog Scale for anxiety (VAS–Anxiety) and performance score ≤1 on the Eastern Cooperative Oncology Group (ECOG) performance status scale. Exclusion criteria included known olfactory deficits, cognitive impairment, and allergies to essential oils. Enrolled patients were randomized (1:1:1) to receive lavender (LOA), linalool oil (LA), or jojoba oil (PA). Following confirmation of olfactory sensitivity, patients received 20 minutes of their assigned aromatherapy immediately prior to BMAB. Anxiety and pain were assessed pretreatment, posttreatment or pre-procedure, intra-procedure, and post-procedure using the VAS–Anxiety, VAS–Pain, Edmonton Symptom Assessment Score (ESAS), and Brief Pain Inventory–Short Form (BPI–SF). Physiologic measures—including EEG activity, heart rate, oxygen saturation, and blood pressure—were measured pretreatment, posttreatment or pre-procedure, and post-procedure. Satisfaction was reported post-procedure using the Post-Procedure Symptom Questionnaire (PPSQ), Study Completion Survey (SCS), and Practitioner Procedure Evaluation Questionnaire (PPEQ). Feasibility was pre-defined as ≥70% aromatherapy treatment completion.

Results:

Of 24 enrolled patients, 21 were evaluable (median age 60; 48% female), and 3 were unevaluable due to scheduling issues/consenting timing. The treatment completion rate was 100% (21/21 of attempted procedures), far exceeding the feasibility threshold of 70%. In regards to satisfaction, 38.1% of the participants agreed and 47.6% strongly agreed that the aromatherapy treatment was relaxing and enjoyable; 66.7% of participants rated their experience with aromatherapy as “very good” and 28.6% of participants as “good;” 85.7% of participants reported that they “would still have chosen to participate in the aromatherapy trial;” 0% of participants indicated that they “would be unwilling to participate in another clinical trial in the future.” Across all arms, the average decrease in VAS - anxiety score before and after the procedure was 4.2 points (p<0.001), with average decreases of 3.0 between the LOA treatment group, 5.7 in the LA treatment group, and 4.2 in the PA group. No significant differences in pain scores were observed.

Conclusion:

Overall, this interim analysis highlights the potential feasibility of incorporating aromatherapy into bone marrow biopsy procedures and suggests a potential anxiolytic benefit of lavender and linalool. The 70% feasibility benchmark was surpassed, warranting continuation of the study. Completion of accrual and full analysis will inform selection of the optimal aromatherapy agent for a larger, more definitive trial to reduce anxiety in patients undergoing BMAB.

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2025
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