title: Integrating mindfulness in supportive cancer care: a cohort study on a mindfulness-based day care clinic for cancer survivors.
abstract: OBJECTIVE
  The aim of this study was to investigate the effects of a mindfulness-based day care clinic group program for cancer survivors on health-related quality of life and mental health; and to investigate which psychological variables are associated with changes in health variables.
  
  
  METHODS
  One hundred seventeen cancer survivors (91.0 % female; mean age 53.9 ± 10.7 years; 65.0 % breast cancer; mean time since diagnosis 27.2 ± 46.5 months) participated in an 11-week mindfulness-based day care clinic group program, 6 h per week. The intervention incorporated mindfulness-based meditation, yoga, cognitive-behavioral techniques, and lifestyle modification. Outcome measures including health-related quality of life (EORTC QLQ-C30), depression and anxiety (HADS); and psychological variables including life satisfaction (BMLSS), mindfulness (FMI), adaptive coping styles (AKU), spiritual/religious attitudes in dealing with illness (SpREUK), and interpretation of illness (IIQ) were assessed before, after, and 3 months after the intervention.
  
  
  RESULTS
  Using mixed linear models, significant improvements in global health status, physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning were found. Cancer-related symptoms, including fatigue, pain, insomnia, constipation, anxiety, and depression, also improved significantly. Mindfulness, life satisfaction, health satisfaction, all coping styles, all spiritual/religious attitudes, and interpretation of illness as something of value increased; interpretation of illness as punishment decreased significantly (all p < 0.05). Improved outcomes were associated with increases in psychological variables, mainly life satisfaction, health satisfaction, and trust in medical help (R (2) = 7.3-43.6 %).
  
  
  CONCLUSIONS
  Supportive mindfulness-based interventions can be considered as an effective means to improve cancer survivors' physical and mental health. Functional improvements are associated with improved satisfaction and coping styles.
authors.affiliation: Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany.
authors.forename: Gustav
authors.initials: G
authors.lastname: Dobos
authors.forename: Tatiana
authors.initials: T
authors.lastname: Overhamm
authors.forename: Arndt
authors.initials: A
authors.lastname: Büssing
authors.forename: Thomas
authors.initials: T
authors.lastname: Ostermann
authors.forename: Jost
authors.initials: J
authors.lastname: Langhorst
authors.forename: Sherko
authors.initials: S
authors.lastname: Kümmel
authors.forename: Anna
authors.initials: A
authors.lastname: Paul
authors.forename: Holger
authors.initials: H
authors.lastname: Cramer
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003631:Day Care, Medical; D005260:Female; D006801:Humans; D008297:Male; D064866:Mindfulness / Q000379:methods*; D009369:Neoplasms / Q000401:mortality / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D017741:Survivors / Q000523:psychology*