The lay public, patients and advocates are not usually aware of how decisions are made by health systems, insurers, or governments concerning the availability of medicines provided through national health systems. Today a variety of health economic analyses are undertaken to determine if a particular therapy is cost effective and meets specific criteria to be covered under the national health service programmes. This decision making process is complicated, and in some countries the methodology used is not transparent; these decisions are not adopted in the same way in all countries and often there is no communication or approval required by the public or patient representatives. This is not acceptable from the patient's perspective as effectiveness must remain the criteria and these decisions must be understood and shared in such a way that all stakeholders agree on guidelines for the approval and delivery of new medicines. Other solutions that impact cost need to be explored--new methods of raising funds for research, public health prevention programmes to reduce the burden in future years and increasing health budgets by taxing items that contribute to the cancer burden such as tobacco and alcohol.