Coping with cancer in post-communist Europe: a systematic literature review

In the post-communist countries, limited access to treatment, lack of financial protection mechanisms, lack of information and low quality of health care frequently imposes an enormous burden on family's well-being when cancer is diagnosed. While many studies have explored barriers to cancer treatment, little attention is paid to the question how patients and their caregivers cope with cancer. In this paper, we systematically review the evidence on patients' coping strategies with cancer in post-communist countries. We performed a literature search in PubMed, JSTOR, Web of Science and EBSCO (CINAHL) to identify papers that describe patients' coping strategies because of organizational and financial barriers to cancer treatment. Papers published between January 1991 and January 2020 were included if they described individual experiences of patients at any stage of cancer treatment. We applied the Preferred Reporting Items for Systematic Literature Review as a guide for our review. In total, 28 publications from post-communist countries were included in this review. They presented evidence on coping strategies and barriers faced by patients when coping with poor access to cancer treatment, lack of finances, lack of information and low quality of health care services. Most sought coping strategies included using personal finances to pay for medical services, medicines and supplies, charitable contributions to the hospital and informal payments; visiting a private medical doctor; using personal connections and looking for additional information. We conclude that coping strategies are similar across post-communist countries and can be seen as an indicator of the shortcomings in cancer treatment. This evidence can be used to study and/or improve access to cancer treatment and improve health care policies. Research on the prevalence and quantification of coping strategies is needed to provide evidence-informed policies for countries that face gaps in cancer treatment.