The malodor associated with tumor necrosis in patients with cancer is a serious problem confronting clinicians in oncology and palliative care worldwide.1 Superficial necrotic malignant ulcers often become superinfected with anaerobic bacteria such as Bacterioides spp., Enterobacter spp., or Escherichia coli.2 These infections may lead to an intensifying foul smell, especially when they connect with the oral or nasal cavity. This malodor clearly magnifies the suffering endured by patients. Patients experiencing the emanation of foul odors often are isolated because of the effect of these odors on other patients. Social isolation becomes increasingly entrenched when, all too often, relatives become reluctant to visit as a result of anticipation of contact with the bad smell. Social contact outside medical and nursing staff becomes rare. Patients' quality of life becomes increasingly poor.1, 2
Patients with malodorous tumors usually receive a standard combination of 600 mg clindamycin plus 60 mg chlorophyll orally twice a day and topical disinfections with Betadine solution (Purdue Pharma, Stamford, CT). This combination reduces only slightly malodorous emanations. In our experience, such an approach has never led to satisfactory deodorization of patients.
We have now started trials using pleasant-smelling antibacterial essential oils to treat patients with inoperable advanced squamous cell carcinoma of the head and neck who suffer from malodorous conditions. These essential oils, such as eucalyptus oil or tea tree oil (Megabac®, Nicrosol Laboratories, Brisbane, Australia), recently have been shown to have high antibacterial activity.3–6 In a previous study, Sherry et al.7 used essential oils to successfully treat patients with chronic methicillin-resistant Staphylococcus aureus infection of diabetic feet, as well as patients with tibial osteomyelitis. The application of these oils is appreciated greatly by our patients, who favorably comment on the fragrance of the eucalyptus-based oils and request their continued use.
In practice, we rinse the ulcers with 5 mL of an antibacterial essential oil mix twice a day. The mixture consists of tea tree oil, grapefruit oil, and eucalyptus oil (Megabac®). In addition, all patients receive the standard medication schedule of clindamycin and chlorophyll, but they do not receive topical Betadine solution. The oil mix can also be administered successfully and easily via a regular pump-spray container.
Twenty-five patients have been treated with this method. The foul smell associated with the necrotic ulcers normally recedes entirely after 2–3 days of treatment. Signs of super-infection and pus secretion are often significantly reduced in necrotic areas. A major positive outcome of this treatment is that patients can be returned to the regular ward and enjoy improved social interactions with relatives, friends, and other patients. Our patients have even returned home and received ongoing essential oil treatment administered by their local doctor or by their relatives. This is made easier through the use of the spray container. The depression experienced as a result of the malodor often disappears when patients return home. The adverse effects of this therapy include a bitter taste and occasionally slight burning pain on application to the intraoral mucosa. However, these are usually well accepted by the patients, especially when the malodor dissipates. Other patients have reported pain relief after rinsing necrotic ulcer cavities, which may have been due to the anesthetic properties of the eucalyptus oil.8 We have not observed any allergic reactions to the essential oils, as has been reported in earlier studies.8 Minor allergic side effects are of small concern given the immense positive outcomes observed in patients with incurable disease.
We suggest that antibacterial essential oils should be introduced into modern palliative care. These oils are inexpensive, available worldwide, and can be administered easily. Given our promising initial results, we have initiated a formal clinical study on this subject and encourage other research groups to investigate the use of these oils in oncology practice.