Aromatherapy

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The effect of lavender on anxiety and sleep quality in patients

E
treated with chemotherapy
Ayse Özkaraman, RN, PhD, Özlem Dügüm, RN, Hülya Özen Yılmaz, MSc, and Öznur Usta Yeşilbalkan, RN, PhD

BACKGROUND: A cancer diagnosis is a serious ESSENTIAL OILS ARE CHEMICALS EXTRACTED FROM PARTS OF PLANTS that have a
stressor that is associated with anxiety, depression, unique aroma and complex chemical properties (National Cancer Institute
sleep disorders, and inability to fulfill daily routines. [NCI], 2018; Worwood, 2016). Essential oils can be inhaled, digested, or
Many pharmacologic and nonpharmacologic applied topically, and they are eliminated from the body through urine and by
options are available to help patients with cancer respiration (Maddocks-Jennings & Wilkinson, 2004; NCI, 2018). They were
manage anxiety. introduced to nursing care by Florence Nightingale, and their use grows daily
by nurses with certification in the use of essential oils (Gnatta, Kurebayashi,
OBJECTIVES: This randomized, controlled trial Turrini, & Silva, 2016; Smith & Kyle, 2008).
examined the effects of lavender oil aromatherapy Lavender is a member of the mint family and contains linalyl acetate,
on anxiety and sleep quality in patients undergoing linalool, and caryophyllene. Lavandula angustifolia increases the effect of
chemotherapy. gamma-Aminobutyric acid on the amygdala and has narcotic and sedative
effects similar to those of benzodiazepines (Conrad & Adams, 2012; Fismer
METHODS: 70 patients were randomly assigned & Pilkington, 2012; Maddocks-Jennings & Wilkinson, 2004). In addition,
to a lavender oil group, a tea tree oil group, and a Lavandula hybrida has relaxing and sedative properties (Price & Price, 2011).
control group with no oil. A patient identification In addition to its antibacterial, antifungal, and carminative characteristics,
form, the State-Trait Anxiety Inventory, and the which increase wound healing and the detoxification of enzymes associated
Pittsburgh Quality Sleep Index (PSQI) were used to with insect bites, lavender has no known contraindications and is safe to
measure anxiety and sleep quality before and after use (Braden, Reichow, & Halm, 2009; Howard & Hughes, 2008; Kritsidima,
chemotherapy. Newton, & Asimakopoulou, 2010; Muzzarelli, Force, & Sebold, 2006).
Inhaling lavender has been reported to have an immediate effect, and topical
FINDINGS: State anxiety before and after chemo- administration takes effect in 10–90 minutes and lasts a few days (Worwood,
therapy did not vary among groups. The authors 2016).
compared trait anxiety values before and after Lavender is used for spiritual relaxation, for therapeutic purposes (to
chemotherapy and found a significant difference in build physical and emotional well-being), and for regulation of sleep disor-
the lavender group. In addition, a significant change ders (Koulivand, Khaleghi Ghadiri, & Gorji, 2013; Kritsidima et al., 2010).
in PSQI measurements before and after chemother- In a study conducted by Franco et al. (2016), 2% lavender oil was admin-
apy was observed. istered to one group of women and odor-free aromatic oil was given to
another group for 10 minutes through an oxygen mask before all under-
went a breast biopsy. Women who inhaled lavender oil reported decreased
negative feelings, and the aromatherapy was shown to be effective in
the management of preoperative anxiety (Franco et al., 2016). Another
KEYWORDS study showed that smelling four drops of 10% lavender oil for four weeks
aromatherapy; lavender; sleep quality; improved sleep quality in postpartum women (Keshavarz Afshar et al.,
anxiety; PSQI; STAI; chemotherapy 2015). Kritsidima at al. (2010) observed the diagnosis and treatment
procedures carried out on a group of patients who visited an outpatient
DIGITAL OBJECT IDENTIFIER clinic for dental treatment in a room where a 10-cc cup of water with 5
10.1188/18.CJON.203-210 drops of lavender oil was located. They observed the procedures con-
ducted on another group in an odor-free room. At the end of the study,

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AROMATHERAPY

they found that the anxiety levels of the patients undergoing

procedures in the room with the lavender aromatherapy were
lower (Kritsidima et al., 2010). Although lavender oil is used
“The use of lavender
for the management of anxiety and sleep disorders in varied
populations, no studies to date have reported on the efficacy
oil significantly
of lavender oil to better manage anxiety and sleep disorders in
patients undergoing chemotherapy.
increased the sleep
Patients with cancer experience symptoms from their disease
and treatment, including fear of death, poor quality of life, and
quality of patients
damaged relationships, which can cause a feeling of a loss of con-
trol, anxiety, and sleep disorders (Chandwani et al., 2012; Chang
with cancer.”
& Lin, 2017; Delsigne, 2013; Graci, 2005; NCI, 2016; Palesh et al.,
2010; Yaranoğlu, 2015). Oncology nurses play an important role in
the pharmacologic and nonpharmacologic management of anxiety or under a certain condition. It was adapted to Turkish by Öner
and sleep disorders. Many pharmacologic treatments are used to and Le Compte (1985) and was used in this study. It has two sub-
manage anxiety and sleep disorders, but they can lead to adverse scales, the State Anxiety Scale (S-Anxiety) and the Trait Anxiety
effects and economic loss (NCI, 2016). Nonpharmacologic treat- Scale (T-Anxiety), which are measured by a four-point Likert-
ments that are effective in treating anxiety and sleep disorders type scale ranging from 1 (never) to 4 (always). According to
include participating in relaxation exercises, listening to music, reliability analysis, the Cronbach alpha internal consistency coef-
shifting attention, practicing sleep hygiene, and using aroma- ficients are from 0.94–0.96 for the S-Anxiety and from 0.83-0.87
therapy (Cramer, Lauche, Langhorst, Dobos, & Paul, 2013; Dóro, for the T-Anxiety, respectively (Kara & Acet, 2012; Şirin, Kavlak,
Neto, Cunha, & Dóro, 2017; Emberly, 2008; Firmeza et al., 2017; & Ertem, 2003). The STAI clearly differentiates between the
Gallagher, Lagman, & Rybicki, 2017; Ovayolu, Seviğ, Ovayolu, temporary condition of state anxiety and the more general and
& Sevinç, 2014; Zupanec et al., 2017). The current study was long-standing quality of trait anxiety, helping professionals dis-
designed to evaluate the effects of lavender oil on anxiety and tinguish between feelings of anxiety and depression.
sleep quality in patients receiving chemotherapy. The PSQI was developed by Buysse, Reynolds, Monk, Berman,
and Kupfer (1989), and Ağargün, Kara, and Anlar (1996) performed
Methods its validity and reliability analyses in Turkey. The Turkish version
Participants was used in this study. Although the PSQI consists of 24 items, it
The study sample consisted of patients with cancer who were is scored using 19 items. It includes open-ended questions, such
receiving chemotherapy in outpatient units. Inclusion criteria as “During the past month, when have you usually gone to bed
were as follows: patients with cancer aged 18 years or older who at night?” as well as multiple-choice questions, such as “During
had the ability to smell, were receiving paclitaxel weekly, agreed the past month, how would you rate your sleep quality overall?”
not to use scented products, and volunteered to participate in the with answers ranging from 0 (very good) to 3 (very bad) or 0 (not
study. The exclusion criteria included having a chronic disease during the past month) to 3 (three or more times a week). It has 7
(cardiovascular disease, asthma), being diagnosed with a psychi- components, each scored from 0–3. Total scores range from 0–21
atric disease (anxiety, panic attacks, depression), having a known points. Scores lower than five points indicate good sleep quality,
history of allergies, and using anxiolytic drugs. and scores higher than five points indicate poor sleep quality
(Ağargün et al., 1996).
Outcome Measures
For the collection of data, the researchers used a patient iden- Data Collection
tification form created for the study, The State-Trait Anxiety Before initiating this study, the researchers obtained written per-
Inventory (STAI), and the Pittsburgh Sleep Quality Index (PSQI). mission from the ethical committee and administration of the
The patient identification form included questions about Private Ümit Hospital in Eskişehir, Turkey. After the researchers
patients’ socio-demographic characteristics (age, sex, educa- recruited patients who met the criteria, they obtained written
tional status, marital status, information about caregivers), sleep consent. Using the random-number method on a computer, the
characteristics (room temperature, sound, light, day and night authors randomized participants to one of three groups (lavender
sleep durations), and disease characteristics (diagnosis, treat- oil group, tea tree oil group, or control group). The patients were
ment, and duration of disease). homogeneously distributed across groups, and the data were
The STAI is a self-evaluation questionnaire that uses short collected by a nurse who was independent of the research team.
statements to evaluate how participants feel in a certain time The patients’ records and group numbers were delivered to the

204   CLINICAL JOURNAL OF ONCOLOGY NURSING  APRIL 2018, VOL. 22 NO. 2 CJON.ONS.ORG
administering nurse in a closed envelope. Numbered labels were Findings
affixed to the bottles of aromatic oils to blind the contents of the Sample Characteristics
bottles to patients and the administering nurse. Of the participants, 30 were in the lavender group, 20 were in the
The researchers bought the lavender essential oil (Lavandula tea tree oil group, and 20 were in the control group. The mean
hybrida) from an herbal product firm with quality certifications, age of the participants was 58.22 years. Most were women and
consisting of business registration G06-3231 from the Ministry were married, and about half were graduates of primary school.
of Food, Agriculture, and Livestock, and ISO 9001:2008 from The distribution of patients by age, sex, educational status, mar-
the International Organization for Standardization. The tea tree ital status, and income level was homogeneous (p < 0.05) (see
oil used in the current study was bought from the same herbal Table 1). In addition, 10 expressed that their income met their
product firm. In their study, Howard and Hughes (2008) used expenses, most had breast cancer, 22 were undergoing paclitaxel-
tea tree oil, which does not have a sedative or relaxing effect, to carboplatin treatment, and 7 had not experienced any symptoms
create a placebo effect, as it was used in the current study. in the past week.
In the first and second stages of the study, lavender oil and tea
tree oil were administered to the respective intervention groups, State-Trait Anxiety Inventory Scores
and no aromatherapy was administered to the control group. According to the S-Anxiety and T-Anxiety scores from the first
Three drops of lavender or tea tree oil were put onto a piece of assessment before chemotherapy, all patients had moderate
cotton that was placed on each patient’s neck and shoulders, state and trait anxiety. In the second assessment, S-Anxiety and
about 10 inches below the nose. T-Anxiety mean scores decreased in all groups.
FIRST ASSESSMENT: The authors used a patient identification Table 2 shows descriptive statistics. In terms of S-Anxiety
form, the STAI (T-Anxiety and S-Anxiety), and the PSQI for the values, no difference was found among groups (F[2.67] = 1.16 , p =
first evaluation of all groups just before the first cycle of chemo- 0.32). The authors did not find a significant change in S-Anxiety
therapy. During chemotherapy, the nurse administered lavender values from the first to second assessment (F[1.67] = 1.981, p =
and tea tree oil to the respective intervention groups. No aroma- 0.164). The change that occurred between S-Anxiety values from
therapy was administered to the patients in the control group. the first to second assessment did not vary by group (F[2.67] =
When the patients completed chemotherapy, the S-Anxiety was 0.826, p = 0.442). The authors did not perform power analysis
readministered to all patients. because no significant difference existed in group, time, or
SECOND ASSESSMENT: The nurse gave written and verbal group * time interaction.
information about the use of lavender or tea tree oil at home to The model established for T-Anxiety showed that no dif-
patients in the respective intervention groups when they were ference existed among all groups (F[2.67] = 1.246, p = 0.294);
discharged after chemotherapy. For one month, the lavender however, considering all participants, a significant change in
group patients and tea tree oil patients smelled the oil every T-Anxiety values was observed from the first to second assess-
night at 9 pm for five minutes at home. After chemotherapy, the ment (F[1.67] = 9.595, p = 0.003), which also differed among
T-Anxiety and PSQI were readministered, and a second evalua- groups (F[2.67] = 11.002, p < 0.001). The researchers examined
tion was performed. reasons for this difference and determined that, when the groups
were compared at the first and second assessments, there was a
Statistical Methods and Data Analysis difference only between the lavender and tea tree oil groups at
Descriptive statistics for quantitative variables were calculated the second assessment (p = 0.046). However, when comparing
and presented as a mean and standard deviation. Frequencies group measurements at the first and second assessments, a sig-
and percentages were given for qualitative variables, and the nificant difference was found only between measurements for the
Shapiro-Wilk test was used to evaluate the normality of quan- lavender group (p < 0.001). The posterior power of these compar-
titative variables. Scores from the scales were assessed with isons performed in terms of the group * time interaction was 98%.
two-way mixed analysis of variance (ANOVA) using general
linear models for repeated measures procedure from IBM SPSS Pittsburgh Sleep Quality Index Scores
Statistics, version 21.0. The model included group and time as In the first assessment performed before chemotherapy, the
main effects and a group * time interaction effect term. Post PSQI mean score for each group was higher than five points; in
hoc testing was carried out only for significant interactions and the second assessment after chemotherapy, the PSQI mean score
was performed using a simple effect analysis with Bonferroni decreased only in the lavender and tea tree oil groups (PSQI: L =
adjustment. The relationship between categorical variables was 3.86 [SE = 0.58], T = 5.9 [SE = 0.722], C = 7.15 [SE = 0.722]).
evaluated using Pearson chi-square analysis. A probability value Given all measurements obtained in this study, no differ-
of less than 0.05 was considered significant, unless otherwise ence existed among groups in terms of PSQI (F[2.67] = 1.721,
noted. p = 0.187); however, the researchers found a significant change

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AROMATHERAPY

TABLE 1.
SAMPLE CHARACTERISTICS

LAVENDER GROUP TEA TREE GROUP CONTROL TOTAL

(N = 30) (N = 20) (N = 20) (N = 70)
— — — —
CHARACTERISTIC X SE X SE X SE X SE p

Age (years) 57.73 12.81 57.55 12.87 59.65 13.37 58.22 12.83 > 0.05

CHARACTERISTIC n n n n

Sex (c2 = 0.917) 0.653

Female 24 17 18 59

Male 6 3 2 11

Educational status (c2 = 0.633) 0.386

Primary school 15 7 11 33

Secondary school 7 9 5 21

High school 4 2 4 10

Literate 4 2 – 6

Marital status (c2 = 0.243) 0.877

Married 24 15 15 54

Single 6 5 5 16

Income level (c2 = 3.118) 0.596

Income meets expenditure 23 15 17 55

Income exceeds expenditure 6 3 1 10

Income does not meet expenditure 1 2 2 5

Cancer type –

Breast 18 12 16 46

Lung 6 3 2 11

Urothelial 1 – 1 2

Ovarian 3 2 1 6

Gastrointestinal 2 – – 2

Unknown origin – 2 – 2

Renal – 1 – 1

Chemotherapy –

Paclitaxel and carboplatin 11 7 4 22

Paclitaxel and trastuzumab 10 7 7 24

Continued on the next page

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TABLE 1. (CONTINUED)
SAMPLE CHARACTERISTICS

LAVENDER GROUP TEA TREE GROUP CONTROL TOTAL

(N = 30) (N = 20) (N = 20) (N = 70)

CHARACTERISTIC n n n n p

Chemotherapy (continued) –

Paclitaxel 3 5 4 12

Paclitaxel, trastuzumab,
5 – 5 10
and carboplatin

Paclitaxel and gemcitabine 1 1 – 2

Symptoms experienced in the past

–
week

Fatigue and weakness 11 15 8 34

Anorexia, fatigue, and pain 15 2 4 21

Numbness in hands and feet 1 1 5 7

None 3 2 3 8

SE—standard error

between the first and second measurement values (F[1.67] = The present study evaluated the immediate anxiety levels of
33.162, p < 0.001), which also differed among groups (F[2.67] = the patients and revealed that the medium level of state anx-
8.991, p < 0.001). In terms of measurement time, this study iety observed in the control group before chemotherapy did not
revealed a significant difference in measurements between the change, along with the state anxiety levels of the two groups that
lavender and control groups only at the second assessment. The smelled lavender oil and tea tree oil during chemotherapy. No
group comparisons showed a significant difference between difference was found the state anxiety levels among groups. A
measurements at the first and second assessments for the lav- study examining the effects of one drop of Lavandula hybrida oil
ender and tea tree oil groups (p < 0.001). The posterior power before surgical operations by Braden et al. (2009) revealed that
of these comparisons in terms of the group * time interaction it reduced patients’ state anxiety. Other studies have also found
was 95%. that the inhalation of lavender oil reduces state anxiety (Koca
Kutlu et al., 2008; Kritsidima et al., 2010). However, the current
Discussion study revealed no effect of Lavandula hybrida oil (three drops) on
The use of lavender oil in different therapeutic activities has participants’ state anxiety, which was largely in agreement with
been explored by various studies (Kianpour, Mansouri, Mehrabi, the findings of other studies (Howard & Hughes, 2008; Perry,
& Asghari, 2016; Koca Kutlu, Yılmaz, & Çeçen, 2008; Maddocks- Terry, Watson, & Ernst, 2012).
Jennings & Wilkinson, 2004; Ovayolu et al., 2014; Smith & Kyle, A study by Bikmoradi et al. (2015) revealed that smelling
2008; Takeda, Watanuki, & Koyama, 2017). Several studies sup- lavender for 20 minutes two days per week did not reduce par-
port the ongoing use of lavender oil as part of an integrated ticipants’ anxiety, and these researchers suggested increasing the
approach to invasive interference (Karadag, Samancioglu, Ozden, duration of aromatherapy to determine the effect of lavender. In
& Bakir, 2017; Trambert, Kowalski, Wu, Mehta, & Friedman, the current study, results did not indicate a significant difference
2017). Aromatherapy massage with lavender oil has had positive in state anxiety levels because the S-Anxiety was administered to
effects on patients with cancer (Ovayolu et al., 2014). In the cur- patients before and after chemotherapy, the time between these
rent study, trait anxiety was reduced and sleep quality improved two administrations was short according to chemotherapy pro-
with the use of lavender oil. tocols (a minimum of one hour and a maximum of four hours),
The first assessment revealed that the sleep quality of each and the patients may have given the same responses at the first
group was poor prior to the use of the oils and that partici- and second assessments because they remembered their prior
pants experienced a moderate level of state and trait anxiety. answers. The time invariance of scales defines the relationship

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AROMATHERAPY

IMPLICATIONS FOR PRACTICE

ɔɔ Evaluate patients’ anxiety and sleep states during treatment.
ɔɔ Use lavender oil, which has a pleasant smell, has no adverse effects,
and is inexpensive, in the management of patients’ anxiety and
among datasets obtained by measuring anything in different time sleep disorders.
periods under similar conditions (Karasar, 2005). In the current ɔɔ Apply knowledge about the use of aromatherapy in nursing
study, the time invariance criterion of the S-Anxiety was not met. practice.
The current study also showed no difference in trait anx-
iety levels among patients in the tea tree oil and control groups
at the first and second assessments, whereas the trait anxiety The current study revealed that the use of lavender signifi-
levels of patients in the lavender group decreased by the second cantly increased the sleep quality of patients with cancer based
assessment. Published studies have reported that, because of its on the assessment time compared to the other two groups. The
anxiolytic and sedative effects (Conrad & Adams, 2012; Fismer sleep quality of patients in the tea tree oil group increased in the
& Pilkington, 2012; Kianpour et al., 2016; Maddocks-Jennings & second assessment compared to the first assessment; however,
Wilkinson, 2004; Woelk & Schläfke, 2010), lavender provides no statistical difference was found between the lavender and con-
spiritual comfort and physical and emotional well-being (Franco trol groups. As with other studies (Karadag et al., 2017; Keshavarz
et al., 2016; Hur, Song, Lee, & Lee, 2014; Koulivand et al., 2013; Afshar et al., 2015), the current study revealed that the use of lav-
Redstone, 2015). Ovayolu et al. (2014) found that aromatherapy ender oil improved sleep quality.
massage and aromatherapy with lavender oil maintain physical Otaghi, Qavam, Norozi, Borji, and Moradi (2017) found that
comfort in the short term and that lavender oil can be used to essential lavender oil was not effective in improving sleep quality.
manage psychological problems in the long term. Essential com- However, Otaghi et al. (2017) did not report on the anxiety level
pounds, such as linalool and linalyl acetate in lavender oil, are of patients. There is a negative relationship between sleep quality
linked to receptors in the olfactory bulb by smelling, and a ther- and anxiety. In the current study, patients began to relax, revealed
apeutic effect arises in the area where actions and moods, such by a decrease in trait anxiety, and their sleep quality improved.
as fear and anger, are controlled and motivated in the limbic Tea tree oil had no effect on state and trait anxiety levels but did
system (Huang & Capdevila, 2017; Koulivand et al., 2013; Lis- increase sleep quality. The current authors hypothesized that tea
Balchin & Hart, 1999; Maddocks-Jennings & Wilkinson, 2004; tree oil had a placebo effect; statistical analyses confirmed the
NCI, 2018). The current study determined that lavender oil is superiority of lavender oil in improving sleep quality.
effective in managing anxiety if it is regularly used every day
for a month. Patients expressed satisfaction with the pleasant Limitations
aroma of lavender in the room when administered during The study is limited to patients who were treated with weekly
chemotherapy. paclitaxel and who completed the STAI and PSQI. The effects

TABLE 2.
DESCRIPTIVE STATISTICS OF STAI AND PSQI SCORES BY GROUP AND TIME

LAVENDER GROUP TEA TREE GROUP CONTROL p

— — —
GROUP AND TIME X SE X SE X SE TIME GROUP GROUP * TIME

S-Anxiety 0.164 0.320 0.442

First assessment 41.4 1.49 45.3 1.82 42 1.82

Second assessment 42.36 1.53 45.3 1.88 42.4 1.88

T-Anxiety 0.003 0.294 < 0.001

First assessment 44.8 1.27 45.4 1.556 45.4 1.556

Second assessment 40.833 1.123 45.25 1.376 45.25 1.376

PSQI < 0.001 0.187 < 0.001

First assessment 7.63 0.82 9.15 1.009 7.05 1.009

Second assessment 3.86 0.58 5.9 0.722 7.15 0.722

PSQI—Pittsburgh Sleep Quality Index; S-Anxiety—State Anxiety Scale; SE—standard error; STAI—State-Trait Anxiety Inventory; T-Anxiety—Trait Anxiety Scale

208   CLINICAL JOURNAL OF ONCOLOGY NURSING  APRIL 2018, VOL. 22 NO. 2 CJON.ONS.ORG
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effects, and it is more cost effective than other complementary Firmeza, M.A., Rodriques, A.B., Melo, G.A.A., Aguiar, M.I.F., Cunha, G.H., Oliveira, P.P., & Moura
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Ayse Özkaraman, RN, PhD, is a lecturer in the Faculty of Health Sciences and https://doi.org/10.1590/s1980-220x2016030503201
Department of Nursing at Eskişehir Osmangazi University; Özlem Dügüm, RN, is Fismer, K.L., & Pilkington, K. (2012). Lavender and sleep: A systematic review of the evidence.
a charge nurse at the Private Ümit Hospital in Eskişehir; Hülya Özen Yılmaz, MSc, European Journal of Integrative Medicine, 4, e436–e447. https://doi.org/10.1016/j.eujim
is a research assistant in the Faculty of Medicine and Department of Biostatistics .2012.08.001
at Eskişehir Osmangazi University; and Öznur Usta Yeşilbalkan, RN, PhD, is an Franco, L., Blanck, T.J.J., Dugan, K., Kline, R., Shanmugam, G., Galotti, A., . . . Wajda, M. (2016).
associate professor in the Faculty of Nursing and Department of Internal Diseases Both lavender fleur oil and unscented oil aromatherapy reduce preoperative anxiety in
at Ege University in İzmir, all in Turkey. Ozkaraman can be reached at aozaydin26@ breast surgery patients: A randomized trial. Journal of Clinical Anesthesia, 33, 243–249.
hotmail.com, with copy to CJONEditor@ons.org. (Submitted May 2017. Accepted https://doi.org/10.1016/j.jclinane.2016.02.032
August 9, 2017.) Gallagher, L.M., Lagman, R., & Rybicki, L. (2017). Outcomes of music therapy interventions on
symptom management in palliative medicine patients. American Journal of Hospice and
The authors take full responsibility for this content. This research was funded in part by the Palliative Medicine, 35, 250–257. https://doi.org/10.1177/1049909117696723
Scientific Research Project Coordination Unit at Eskişehir Osmangazi University. The article has Gnatta, J.R., Kurebayashi, L.F.S., Turrini, R.N.T., & Silva, M.J.P. (2016). Aromatherapy and nursing:
been reviewed by independent peer reviewers to ensure that it is objective and free from bias. Historical and theoretical conception [Article in Portuguese]. Revista da Escola de Enferma-
gem da USP, 50, 130–136. https://doi.org/10.1590/S0080-623420160000100017
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