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The Effectiveness of aromatherapy and its supportive Interventions on anxiety and pain among breast cancer patients: A systematic review and meta-analysis

Introduction: Breast cancer treatments are often associated with pain and anxiety, which can hinder physical functioning and overall quality of life, even after treatment. Complementary therapies, such as aromatherapy, can be used to alleviate pain and reduce anxiety in breast cancer patients. This project aimed to synthesize current global evidence on the effectiveness of aromatherapy. Method: This systematic review followed the PRISMA 2020 guidelines, with a comprehensive, systematic search conducted in PubMed, CINAHL, Cochrane Library, and SCOPUS for randomized controlled trials (RCTS) published from 2015 to 2025. Eligible studies included adult women breast cancer surgery patients who received aromatherapy during various periods of breast cancer. Where possible, data from the included studies were pooled using meta-analysis. GRADE approach was used to assess certainty of findings. Results: The search yielded 84 studies. Out of these, six were included in this review. On average, aromatherapy reduces pain and anxiety scores by 0.79 (standard mean difference (SMD)=-0.79, 95% CI -1.42, -0.16) and 0.53 (SMD=-0.53, 95 CI=-0.90, -0.16) units, respectively, compared to control condition [Low-quality of evidence]. The combination of aromatherapy with music reduces pain and anxiety by 1.26 (SMD= -1.26, 95 CI=-1.65, -0.87) and 1.08 (SMD = -1.08, 95 % CI: -1.45, -0.70) units respectively compared to standard care [Low-quality of evidence]. Conclusion: There is a potential role for the use of aromatherapy and music therapy, to alleviate anxiety and pain, especially for non-preoperative anxiety and pain. Further research is needed to inform the integration of aromatherapy into the management of anxiety and pain.

Population-scale genomics reveals divergent pathogenicity of variant classes across paralogous collagen IV genes

Monoallelic pathogenic or likely pathogenic variants in COL4A3 and COL4A4 occur in approximately 1 in 106 individuals, yet whether these paralogous genes confer equivalent pathogenicity for the same variant classes has not been tested at population scale. Using whole-genome sequencing data from the UK Biobank (UKB; n = 500,000), with replication in the All of Us Research Program (n = 414,000), we performed per-variant association testing, gene-based collapsing analyses and phenome-wide association studies (PheWAS) across haematuria, proteinuria and chronic kidney disease. We identified 64 COL4A3 and 92 COL4A4 rare variants significantly associated with haematuria or proteinuria, generating a quantitative allelic series for clinical variant interpretation. Glycine substitutions within collagenous domains conferred similar risks in both genes. In contrast, truncating and non-collagenous domain (NC1) missense variants were strongly associated with haematuria and proteinuria in COL4A4 carriers but showed substantially attenuated or absent associations in COL4A3 carriers despite comparable carrier frequencies and predicted pathogenicity scores. These findings were independently replicated in All of Us. Genome-wide association analysis identified the COL4A3/COL4A4 locus as the dominant genetic determinant of haematuria, with the signal attributable to the aggregate effects of rare coding variants and no evidence of independent common variant or trans-acting modifier effects. These findings demonstrate substantial gene-specific differences in tolerance to truncating and NC1 variants between COL4A3 and COL4A4, challenging assumptions of equivalent pathogenicity across paralogous collagen IV genes. Gene identity and not variant class alone, should inform risk stratification, variant interpretation and genetic counselling in individuals carrying collagen IV risk genotypes.