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CME / ABIM MOC / CE

Can Rose Geranium Oil Ease Chemo-Induced Nasal Pain?

  • Authors: News Author: Fran Lowry; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 12/7/2018
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 12/7/2019
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Target Audience and Goal Statement

This article is intended for primary care physicians, oncologists, otolaryngologists, nurses, pharmacists, and other physicians who treat and manage patients with cancer who have persistent severe nasal symptoms.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  • Assess the problem of nasal vestibulitis among patients with cancer
  • Evaluate the efficacy and tolerability of rose geranium in sesame oil in the treatment of nasal vestibulitis in patients with cancer
  • Outline implication for the healthcare team


Disclosures

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Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


News Author

  • Fran Lowry

    Freelance writer, Medscape

    Disclosures

    Disclosure: Fran Lowry has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Clinical Professor, Health Sciences
    Department of Family Medicine
    University of California, Irvine School of Medicine

    Disclosures

    Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Shire Pharmaceuticals; Sunovion Pharmaceuticals Inc.
    Served as a speaker or a member of a speakers bureau for: Shire Pharmaceuticals

Editor

  • Esther Nyarko, PharmD

    Associate CME Clinical Director, Medscape, LLC

    Disclosures

    Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

  • Amy Bernard, MS, BSN, RN-BC, CHCP

    Lead Nurse Planner, Medscape, LLC

    Disclosures

    Disclosure: Amy Bernard, MS, BSN, RN-BC, CHCP, has disclosed no relevant financial relationships.


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CME / ABIM MOC / CE

Can Rose Geranium Oil Ease Chemo-Induced Nasal Pain?

Authors: News Author: Fran Lowry; CME Author: Charles P. Vega, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME / ABIM MOC / CE Released: 12/7/2018

Valid for credit through: 12/7/2019

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Clinical Context

Cancer treatment is associated with a wide variety of adverse events, and epidermal growth factor receptor inhibitors (EGFRis) have been associated with a number of different skin reactions in particular. Ruiz and colleagues evaluated the epidemiology of nasal vestibulitis associated with EGFRis and shared their results in the August 2015 issue of Supportive Care in Cancer.[1]

Researchers evaluated the medical records of 115 patients with cancer referred to dermatologists for nasal vestibulitis: 13% of these patients experienced multiple episodes of nasal vestibulitis. The most common underlying malignancy among all patients in the series was lung cancer, and 68% of patients had been treated with an EGFRi; 94% of nasal cultures were positive for bacteria, the most common of which was Staphylococcus aureus.

Rose geranium in sesame oil may help to improve nasal vestibulitis because of cancer therapy, but research into this treatment is lacking. The current study by Cathcart-Rake and colleagues addresses this issue.

Study Synopsis and Perspective

A nasal spray that contains rose geranium in sesame oil may soothe painful nasal symptoms associated with cancer-directed therapy, said researchers from the Mayo Clinic, Rochester, Minnesota.

Patients with breast cancer who were prescribed the spray reported relief from nasal symptoms they were experiencing as a result of their chemotherapy, particularly if that therapy involved taxanes.

These nasal symptoms included bleeding, dryness, pain, scabbing, and sores.

"Most of the patients reported a significant benefit and with very minimal side effects," lead author Elizabeth Cathcart-Rake, MD, an oncology fellow at Mayo Clinic, Rochester, told Medscape Medical News.

The study was published online in BMJ Supportive and Palliative Care.[2]

"One of our nurse practitioners who works with the breast cancer team here at Mayo noticed these symptoms in her patients. Her husband had been using rose geranium spray for his nasal symptoms, and she discovered that this is a preparation that is used frequently for a number of different ENT [ear, nose, and throat]–type indications," Dr Cathcart-Rake said.

Her team previously reported a study of the frequency of nasal symptoms associated with chemotherapy.[3] "We found it to occur in about 40% of patients receiving cancer-directed therapy. But that goes up to about 70% in patients who are receiving taxane chemotherapy," she said.

After they noticed the benefits of the rose geranium nasal spray, Dr Cathcart-Rake and her team sought to assess these benefits in a formal study.

They identified 40 patients with breast cancer who had been prescribed rose geranium nasal spray at their institution between August 2007 and August 2017 and sent them questionnaires about their experiences.

All of the patients were receiving cancer-directed therapy, and 58% were receiving taxane chemotherapy. Others were receiving a variety of cytotoxic treatments and targeted therapy.

Of the 40 patients, surveys were returned by 21; of those, 20 said that they had used the nasal spray.

The nasal symptoms they reported included bleeding (90%), dryness (86%), pain (81%), scabbing (67%), and sores (52%). The reported baseline severity of nasal symptoms was an average of 2.9, which corresponded to a score of "moderate" to "marked" on a scale of 1 to 4.

Ten of the patients reported that they had used the nasal spray daily, and 45% said they had used it several times a day. One patient said she had used it a few times.

All patients who used the rose geranium nasal spray reported symptomatic benefit.

On a scale of 1 to 4, 11 (55%) participants reported a score of 2, which corresponded with moderate benefit. Six (30%) participants reported dramatic benefit (score of 3), and 2 (10%) patients reported complete resolution of their symptoms (score of 4). One patient reported little benefit (score of 1).

Two patients reported experiencing unpleasant effects from using the nasal spray. One said it was "messy and difficult to apply," and the other stated it left an oil coating in the back of her throat.

"It's not completely clear how rose geranium oil works to soothe nasal symptoms, and sesame oil itself has been used for centuries to help with nasal symptoms due to different causes. I'm not sure how this is helpful, but we don't have any other treatments, and this is one that we found anecdotally to be helpful. Certainly, there is a need to study this prospectively," Dr Cathcart-Rake said.

Physicians should ask their patients who are receiving chemotherapy about nasal symptoms, she added.

"If you don't ask, you don't get the information. Nasal symptoms is a popular topic that is all over the cancer blogs, so just asking the question is the most helpful thing you can do," she said.

The study was sponsored by the Breast Cancer Research Foundation. Dr Cathcart-Rake has disclosed no relevant financial relationships. The original article contains a full listing of coauthors' relevant financial relationships.

Study Highlights

  • Study patients had all received breast cancer care at one tertiary care center in Minnesota between 2007 and 2017, and pharmacy records indicated that they had received rose geranium in sesame oil.
  • Researchers reviewed participants’ medical records for demographic, health habit, and medical background. Patients were asked to complete a survey that described any symptoms of nasal vestibulitis along with how effective and well-tolerated rose geranium was in the treatment of vestibulitis.
  • 40 patients provided data for study analysis. The median age of participants was 55 years, and all patients were receiving cancer-directed therapy. 58% were receiving taxane-containing chemotherapy.
  • The most common symptoms reported in chart reviews were nasal dryness (30%), nasal discomfort (63%), bleeding (65%), sores (25%), and scabbing (13%).
  • 21 of 40 participants returned surveys that described the severity of symptoms of nasal vestibulitis and treatment.
  • Patients consistently reported more symptoms in the survey compared with what had been recorded in the medical record. The average severity of symptoms on the survey was “moderate” to “marked”.
  • 20 of 21 participants reported they used the prescribed rose geranium spray; the remaining patient reported that she did not use the spray, as she did not need it because she had stopped cancer-directed therapy.
  • 45% of patients who used rose geranium spray did so several times daily.
  • All participants reported that the rose geranium spray helped their symptoms. 55% of patients reported a moderate degree of benefit associated with rose geranium spray. 30% reported dramatic improvement, and 10% had complete resolution of their symptoms.
  • Symptom severity did not significantly affect the efficacy of rose geranium spray.
  • 2 patients reported adverse effects associated with the rose geranium spray (messy to apply and sensation of an oil coating on the back of the throat).

Clinical Implications

  • In a series of patients with cancer referred to dermatologists for nasal vestibulitis, the most common underlying malignancy among all patients in the series was lung cancer. Of these patients, 68% had been treated with an EGFRi, and 13% of all patients experienced multiple episodes of nasal vestibulitis; 94% of nasal cultures were positive for bacteria, the most common of which was S aureus.
  • Rose geranium in sesame oil was effective for all patients with nasal vestibulitis related to cancer-related therapy in the current study, as 40% of study participants reported dramatic or complete improvement. Treatment was also well-tolerated overall.
  • Implications for the Healthcare Team: Rose geranium in sesame oil may be a good treatment alternative for nasal vestibulitis related to cancer-related therapy, but a prospective clinical trial would be helpful to establish its benefits vs disadvantages in this patient population.
  • The role of the healthcare team member is to continue to enhance their own knowledge through seeking up to date evidence, guide and support patients to improve outcomes, in collaboration with other members of the healthcare team. 

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