A randomized controlled pilot study of aromatherapy to reduce anxiety and pain during bone marrow aspiration and biopsy.

12140 Background: Bone marrow aspiration and biopsy (BMAB) is associated with substantial anxiety and pain among patients with hematologic malignancies. Nonpharmacologic strategies to improve procedural tolerance are needed. Aromatherapy with lavender essential oil and its primary active constituent, linalool, has demonstrated anxiolytic effects in preclinical and peri-procedural settings but has not been rigorously evaluated during BMAB. Methods: We conducted a single-center, randomized pilot study of adult patients with cancer receiving a BMAB. Subjects were randomized (1:1:1) to lavender essential oil (≥25% linalool), pure linalool oil (≥97%), or placebo (jojoba oil). Aromatherapy was administered via inhalation prior to and throughout the procedure. Primary outcomes included feasibility (>70% completion) and patient satisfaction. Secondary outcomes included anxiety and pain assessed by visual analog scales (VAS) before, during, and after BMAB. Exploratory physiologic outcomes included bispectral index (BIS), an electroencephalogram-based measure of cortical arousal. Results: Forty-five patients were enrolled, with 43 (96%) completing the study, meeting feasibility criteria. Most participants (88%) agreed or strongly agreed that aromatherapy was relaxing and enjoyable. All groups demonstrated significant within-group reductions in VAS-anxiety from pre- to post-procedure, with the largest reduction observed in the linalool arm (−3.1±0.70 (mean±SE); p<0.01), compared with lavender (−1.8±0.67; p=0.02) and placebo (−2.4±0.61; p<0.01). During BMAB, anxiety reduction favored the lavender and linalool arms, with a trend toward between-group significance (p=0.053). Pain increased during BMAB across all groups; however, the linalool arm demonstrated the smallest increase (2.6±0.69; p<0.01)) compared with lavender (3.8±0.93; p<0.01)) and placebo (4.0±1.3; p<0.01). Post-BMAB, between group analysis trended toward significantly less pain with lavender and linalool compared to placebo (p=0.057). Exploratory within-group BIS scores analyses demonstrated significant reductions in average BIS after aromatherapy treatment prior to BMAB with lavender showing the greatest reductions (-6.0±2.0; p=0.01), as compared to linalool (-3.6±1.6; p=0.047) and placebo (-1.6±1.3, p=0.27). No serious adverse events occurred. Conclusions: Aromatherapy using lavender and linalool during BMAB is feasible, safe, and potentially associated with meaningful reductions in procedural anxiety and pain. These preliminary findings support a larger randomized control trial to confirm efficacy and explore integration into routine supportive oncology care. Clinical trial information: NCT06581211 .