It can be a challenge for a healthcare system to facilitate access to novel cancer drugs. This can be due to lack of transparency regarding alternative access pathways before or after authorisation, absence of reimbursement due to uncertainties regarding clinical value and cost-effectiveness, lengthy price-negotiations and practice variation among hospitals, for instance in conducting molecular diagnostics. Based on three daily practice examples, we discuss the current challenges and complex procedures in providing access through alternative pathways, such as early-access or free-of-charge programmes in the Netherlands. Policymakers, funders, and medical societies need to harmonise procedures, increase transparency regarding treatment and testing options and collaborate more to ensure equal and timely access to valuable cancer therapies. Accurate and responsible communication and reporting regarding the efficacy and availability of novel treatments is crucial to prevent unrealistic expectations, disappointment, and distress among patients and the public.