{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:42:59Z","timestamp":1785544979455,"version":"3.56.0"},"reference-count":44,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Res Protoc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Psychoneurological symptom clusters (PNSCs) are common in patients with ovarian cancer and are associated with reduced quality of life, treatment interruption, and poor prognosis. However, effective interventions for PNSCs remain limited. Traditional Chinese medicine may provide comprehensive benefits for symptom management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to evaluate the efficacy and safety of the TiaoShenZhiAi (TSZA) regimen in alleviating PNSCs in patients with ovarian cancer and to assess its effects on quality of life and survival outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 316 patients with ovarian cancer aged 18 to 70 years with PNSCs will be included and randomly divided into 2 parallel groups. Both groups will receive standard treatment for ovarian cancer as the basic treatment. The intervention group will receive the TSZA regimen, that is, Compound Ciwujia Granules (containing\n                      <jats:italic>Acanthopanax senticosus<\/jats:italic>\n                      and\n                      <jats:italic>Schisandra chinensis<\/jats:italic>\n                      ) combined with psychological intervention. The control group will receive a low-dose active control (simulated Compound Ciwujia Granules) combined with psychological intervention. The primary outcome is the remission rate of PNSCs at 3 months. The secondary outcome measures include the Pittsburgh Sleep Quality Index, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale, the revised Piper Fatigue Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 Quality of Life Scale, the traditional Chinese medicine syndrome scale, sleep quality, sleep diary, and the 1-year survival analysis. In addition, this study also includes a series of exploratory indicators (including functional magnetic resonance imaging, biomarkers of peripheral blood and tumor tissue, proportion of immune cells, cytokine levels, hypothalamic-pituitary-adrenal axis function, and immune gene expression analysis) and safety indicators (including vital signs, liver and kidney function, and electrocardiogram). The study outcomes will be evaluated based on different indicators during the treatment period (baseline and the 1st, 2nd, and 3rd mo of enrollment) and the follow-up period (the 6th, 9th, and 12th mo of enrollment). Data analysis will be conducted using R (version 4.5.3) software. A one-sided\n                      <jats:italic>P<\/jats:italic>\n                      value of &lt;.03 will be considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This study is designed to enroll a total of 316 participants. Participant enrollment is set to commence in October 2025, with no recruitment having occurred as of April 2026. The recruitment period will extend until September 2028 or until the target enrollment is met. Data analysis is scheduled for November 2028, with submission of the trial results to a peer-reviewed journal anticipated by May 2029.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study will evaluate the efficacy of the TSZA regimen in managing PNSCs in patients with ovarian cancer and generate clinical evidence for a new therapeutic option that improves quality of life and alleviates the symptom burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/88625","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T11:05:06Z","timestamp":1777287906000},"page":"e88625-e88625","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the TiaoShenZhiAi Regimen for Patients With Ovarian Cancer Experiencing a Psychoneurological Symptom Cluster: Protocol for a Multicenter, Double-Blind, Randomized Controlled Trial"],"prefix":"10.2196","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8929-7608","authenticated-orcid":false,"given":"Ze","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5563-8007","authenticated-orcid":false,"given":"Jialiang","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4545-9247","authenticated-orcid":false,"given":"Xinyi","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4098-8496","authenticated-orcid":false,"given":"Yun","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9864-4004","authenticated-orcid":false,"given":"Bin","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0992-635X","authenticated-orcid":false,"given":"Yanhong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6761-7569","authenticated-orcid":false,"given":"Xi","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9656-9262","authenticated-orcid":false,"given":"Wei","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1492-7001","authenticated-orcid":false,"given":"Guowang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0927-2323","authenticated-orcid":false,"given":"Jing","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1266-8943","authenticated-orcid":false,"given":"Jiuda","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1577-9179","authenticated-orcid":false,"given":"Jianhui","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"issue":"3","key":"R1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","journal-title":"CA Cancer J Clin"},{"issue":"11","key":"R2","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.1089\/jpm.2011.0112","article-title":"Subgroups of advanced cancer patients clustered by their symptom profiles: quality-of-life outcomes","volume":"14","author":"Husain","journal-title":"J Palliat Med"},{"issue":"4","key":"R3","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1016\/j.jpainsymman.2009.09.005","article-title":"Significance of symptom clustering in palliative care of advanced cancer patients","volume":"39","author":"Tsai","journal-title":"J Pain Symptom Manage"},{"issue":"1","key":"R4","first-page":"21","volume":"1","author":"Sarna","journal-title":"Cancer Pract"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1097\/SPC.0b013e32835defac","article-title":"Cancer symptom cluster research: new perspectives and tools","volume":"7","author":"Barsevick","journal-title":"Curr Opin Support Palliat Care"},{"issue":"3","key":"R6","first-page":"465","volume":"28","author":"Dodd","journal-title":"Oncol Nurs Forum"},{"issue":"32","key":"R7","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1093\/jncimonographs\/lgh023","article-title":"Symptom clusters: the new frontier in symptom management research","author":"Miaskowski","journal-title":"J Natl Cancer Inst Monogr"},{"issue":"5","key":"R8","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1097\/01.NCC.0000290809.61206.ef","article-title":"Symptom clusters and quality of life in survivors of ovarian cancer","volume":"30","author":"Fox","journal-title":"Cancer Nurs"},{"issue":"5","key":"R9","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1016\/j.jpainsymman.2009.09.012","article-title":"Symptom cluster patterns during the first year after diagnosis with cancer","volume":"39","author":"Molassiotis","journal-title":"J Pain Symptom Manage"},{"issue":"2","key":"R10","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s40675-017-0068-1","article-title":"Using mindfulness for the treatment of insomnia","volume":"3","author":"Ong","journal-title":"Curr Sleep Med Rep"},{"issue":"48","key":"R11","doi-asserted-by":"publisher","first-page":"48","DOI":"10.3389\/fneur.2012.00048","article-title":"Exercise effects on sleep physiology","volume":"3","author":"Uchida","journal-title":"Front Neurol"},{"issue":"3","key":"R12","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-025-09213-2","article-title":"The effect of music therapy on anxiety, depression, pain and sleep quality of lung cancer patients: a systematic review and meta-analysis","volume":"33","author":"Li","journal-title":"Support Care Cancer"},{"issue":"S1","key":"R13","doi-asserted-by":"publisher","DOI":"10.1096\/fasebj.2022.36.S1.R5335","article-title":"Individualized estrogen dosing in women undergoing premenopausal bilateral oophorectomy","volume":"36","author":"Harvey","journal-title":"FASEB J"},{"issue":"12","key":"R14","doi-asserted-by":"publisher","first-page":"1983","DOI":"10.1136\/ijgc-2020-002001","article-title":"Psychosexual morbidity in women with ovarian cancer","volume":"30","author":"Logue","journal-title":"Int J Gynecol Cancer"},{"issue":"1","key":"R15","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-021-01375-5","article-title":"Body image dissatisfaction and lower self-esteem as major predictors of poor sleep quality in gynecological cancer patients after surgery: cross-sectional study","volume":"21","author":"Aquil","journal-title":"BMC Womens Health"},{"issue":"9","key":"R16","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-025-09862-3","article-title":"Psychological distress, body image, and nutritional status during hospitalization for gynecological cancer surgery: a prospective observational study","volume":"33","author":"Lafuenti","journal-title":"Support Care Cancer"},{"issue":"6","key":"R17","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.13645","article-title":"\u2018Sometimes I can\u2019t look in the mirror\u2019: recognising the importance of the sociocultural context in patient experiences of sexuality, relationships and body image after ovarian cancer","volume":"31","author":"Boding","journal-title":"Eur J Cancer Care (Engl)"},{"issue":"14","key":"R18","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1001\/jama.2025.9495","article-title":"Ovarian cancer: a review","volume":"334","author":"Caruso","journal-title":"JAMA"},{"issue":"1","key":"R19","doi-asserted-by":"publisher","DOI":"10.1186\/s40364-025-00818-7","article-title":"Therapeutic landscape of ovarian cancer: recent advances and emerging therapies","volume":"13","author":"Wang","journal-title":"Biomark Res"},{"issue":"34","key":"R20","doi-asserted-by":"publisher","first-page":"4051","DOI":"10.1200\/JCO.24.00099","article-title":"Effect of adding electroacupuncture to standard triple antiemetic therapy on chemotherapy-induced nausea and vomiting: a randomized controlled clinical trial","volume":"42","author":"Shen","journal-title":"J Clin Oncol"},{"issue":"6","key":"R21","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-024-08529-9","article-title":"Acupuncture for the treatment of the pain-fatigue-sleep disturbance-numbness\/tingling symptom cluster in breast cancer survivors: a feasibility trial","volume":"32","author":"Kwon","journal-title":"Support Care Cancer"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-023-11789-z","article-title":"Efficacy and safety of traditional Chinese medicine in the treatment of menopause-like syndrome for breast cancer survivors: a systematic review and meta-analysis","volume":"24","author":"Wang","journal-title":"BMC Cancer"},{"issue":"23","key":"R23","doi-asserted-by":"publisher","first-page":"2656","DOI":"10.1200\/JCO.2016.71.0285","article-title":"Tai chi chih compared with cognitive behavioral therapy for the treatment of insomnia in survivors of breast cancer: a randomized, partially blinded, noninferiority trial","volume":"35","author":"Irwin","journal-title":"J Clin Oncol"},{"key":"R24","unstructured":"MDASI ovarian cancer module. Cancer UT MD Anderson. URL: https:\/\/www.mdanderson.org\/research\/departments-labs-institutes\/departments-divisions\/symptom-research\/symptom-assessment-tools\/md-anderson-symptom-inventory-ovarian-cancer-module.html [Accessed 20-09-2025]"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2015.01.009","article-title":"The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis","volume":"25","author":"Mollayeva","journal-title":"Sleep Med Rev"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.09.131","article-title":"Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): a systematic review","volume":"279","author":"Costantini","journal-title":"J Affect Disord"},{"issue":"10","key":"R27","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","journal-title":"Arch Intern Med"},{"issue":"6","key":"R28","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare10060985","article-title":"Evaluation of the psychometric properties of the revised Piper Fatigue Scale in patients with multiple sclerosis","volume":"10","author":"Berardi","journal-title":"Healthcare (Basel)"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2022.03.039","article-title":"Clustering of EORTC QLQ-C30 health-related quality of life scales across several cancer types: validation study","volume":"170","author":"Machingura","journal-title":"Eur J Cancer"},{"issue":"2","key":"R30","doi-asserted-by":"publisher","first-page":"287","DOI":"10.5665\/sleep.1642","article-title":"The consensus sleep diary: standardizing prospective sleep self-monitoring","volume":"35","author":"Carney","journal-title":"Sleep"},{"issue":"11","key":"R31","doi-asserted-by":"publisher","first-page":"3160","DOI":"10.1111\/cns.14314","article-title":"The effects of noninvasive brain stimulation on cognitive function in patients with mild cognitive impairment and Alzheimer\u2019s disease using resting-state functional magnetic resonance imaging: a systematic review and meta-analysis","volume":"29","author":"Wang","journal-title":"CNS Neurosci Ther"},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2024.1341114","article-title":"The multifaceted role of quaking protein in neuropsychiatric disorders and tumor progression","volume":"18","author":"Guo","journal-title":"Front Neurosci"},{"issue":"1","key":"R33","doi-asserted-by":"publisher","DOI":"10.1186\/s13048-019-0503-7","article-title":"Biomarkers and algorithms for diagnosis of ovarian cancer: CA125, HE4, RMI and ROMA, a review","volume":"12","author":"Dochez","journal-title":"J Ovarian Res"},{"issue":"43\u201365","key":"R34","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.physbeh.2016.11.014","article-title":"A users guide to HPA axis research","volume":"178","author":"Spencer","journal-title":"Physiol Behav"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2015.10.007","article-title":"Symptom clusters of ovarian cancer patients undergoing chemotherapy, and their emotional status and quality of life","volume":"21","author":"Hwang","journal-title":"Eur J Oncol Nurs"},{"issue":"12","key":"R36","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1038\/s41568-021-00395-5","article-title":"Stress and cancer: mechanisms, significance and future directions","volume":"21","author":"Eckerling","journal-title":"Nat Rev Cancer"},{"issue":"8","key":"R37","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1038\/s41568-025-00831-w","article-title":"Neuro-immune cross-talk in cancer","volume":"25","author":"Amit","journal-title":"Nat Rev Cancer"},{"issue":"3","key":"R38","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.ccell.2024.01.013","article-title":"Chronic stress increases metastasis via neutrophil-mediated changes to the microenvironment","volume":"42","author":"He","journal-title":"Cancer Cell"},{"issue":"6","key":"R39","doi-asserted-by":"publisher","first-page":"1680","DOI":"10.1038\/s41591-024-02929-4","article-title":"Association between pretreatment emotional distress and immune checkpoint inhibitor response in non-small-cell lung cancer","volume":"30","author":"Zeng","journal-title":"Nat Med"},{"issue":"1","key":"R40","doi-asserted-by":"publisher","DOI":"10.3390\/molecules24010132","article-title":"Anxiolytic effects of  HARMS occur via regulation of autonomic function and activate hippocampal BDNF","volume":"24","author":"Miyazaki","journal-title":"Molecules"},{"issue":"3","key":"R41","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1016\/j.jep.2013.05.026","article-title":"Protective effects of aqueous extract from Acanthopanax senticosus against corticosterone-induced neurotoxicity in PC12 cells","volume":"148","author":"Wu","journal-title":"J Ethnopharmacol"},{"issue":"1","key":"R42","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-74866-4","article-title":"Combination of syringaresinol-di-O-\u03b2-D-glucoside and chlorogenic acid shows behavioral pharmacological anxiolytic activity and activation of hippocampal BDNF-TrkB signaling","volume":"10","author":"Miyazaki","journal-title":"Sci Rep"},{"issue":"3","key":"R43","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1111\/jebm.12485","article-title":"Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta\u2010analysis","volume":"15","author":"Gao","journal-title":"J Evidence Based Medicine"},{"issue":"15_suppl","key":"R44","doi-asserted-by":"publisher","first-page":"5554","DOI":"10.1200\/JCO.2021.39.15_suppl.5554","article-title":"Symptom identification and management in epithelial ovarian cancer","volume":"39","author":"Hickman","journal-title":"J Clin Oncol"}],"container-title":["JMIR Research Protocols"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e88625","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:24:54Z","timestamp":1785536694000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e88625"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":44,"URL":"https:\/\/doi.org\/10.2196\/88625","relation":{},"ISSN":["1929-0748"],"issn-type":[{"value":"1929-0748","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]},"article-number":"v15i3e88625"}}