Participants assigned to this arm received routine radiotherapy care in addition to an adapted mindfulness-based stress reduction program delivered over four weeks consisting of eight structured face-to-face sessions with guided home mindfulness practice. The program included breathing awareness, body scan, sitting meditation, mindful movement, stress education, and group discussion.

Participants in this arm received the oncology center's usual radiotherapy-related care, routine nursing care, medical follow-up, and available supportive or referral services according to standard practice.

An adapted mindfulness-based stress reduction program delivered over four weeks consisting of eight structured sessions including breathing awareness, body scan, sitting meditation, mindful movement, stress education, group discussion, and guided home practice.

The Five Facet Mindfulness Questionnaire is a 39-item self-report instrument assessing five dimensions of mindfulness: observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience. Items are rated on a 5-point Likert scale ranging from 1 (never or very rarely true) to 5 (very often or always true). Higher scores indicate greater mindfulness. Scores were assessed at baseline, immediately after the 4-week intervention, and 1 month after intervention completion.

The Depression Anxiety and Stress Scale-21 (DASS-21), developed by Lovibond and Lovibond (1995), is a 21-item self-report instrument comprising three 7-item subscales assessing depression, anxiety, and stress. Each item is rated from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time). Scores for each subscale range from 0 to 21 and are multiplied by 2 to correspond to the full 42-item DASS scoring system, producing a score range of 0 to 42 for each subscale. Higher scores indicate greater symptom severity.

The Herth Hope Index (HHI) is a clinical-setting adaptation form of the Herth Hope Scale (HHS). This scale was developed by Herth, at Minnesota State in the USA (Herth, 1992). It is composed of 12 items, which are rated on a four points Likert scale. The responses ranged from 1 (strongly disagree) to 4 (strongly agree). Items 3 and 6 are reversed in their score. The twelve items are summed to obtain a total score that ranges from 12 to 48, with a higher score equating to a higher level of hope. The instrument contains three factors, namely temporality & future, positive readiness & expectancy, and finally interconnectedness with self and others.