Funding expensive new cancer therapies is increasingly problematic for healthcare systems worldwide. In this study wthe authors report UK clinicians' views and experiences when discussing expensive anti-cancer drugs with patients. A study-specific survey was emailed to members of relevant professional oncology organisations between April and August 2010: 368 clinicians responded. During the previous 12 months, 71% had made exceptional/individual funding requests; few were successful. Only 9% of clinicians discussed expensive drugs with all patients, 75% with 'some' and 16% with 'none'. Among those who told 'some', 81% (224/276) did so only if convinced of clinical benefit, 72% only if patients initiated the subject, and 55%, if relatives did. Clinicians treating both privately funded and NHS patients (43%) were three times more likely to discuss expensive treatments (p<0.001) than those working only within the NHS. Clinicians' reporting of patients' and relatives' reactions to such discussions was 'understanding' (63%, 45%), 'distress' (40%, 41%) and 'indignation' (24%, 38%). A majority of clinicians (98%) had received no guidance on conducting such discussions and 76% wanted training. This survey clearly demonstrated that few clinicians discuss expensive anti-cancer treatments with their patients and welcome access to a training programme to assist them.