Medicines can save and improve lives but may also come at an enormous cost and, in many cases, do not have major effects on overall survival. While this is true of all classes of medicines, it is particularly true of new cancer medicines. Despite the high costs and questionable benefits of many cancer therapies, patients, their advocates, and some clinicians are increasingly demanding earlier access to more of these medicines. In order to investigate the impact of these claims on doctors, we interviewed sixteen Australian physicians with a background in haematology or oncology and analyzed these thematically. Physicians identified two potential tensions that arose when prescribing high cost cancer medicines: the need to simultaneously provide patients with hope and compassionate care while making decisions on the basis of evidence of efficacy and safety, and the need to simultaneously advocate for patients while limiting waste and using limited health resources wisely. Physicians identified a number of potential strategies to navigate these tensions, including deferring to experts and policymakers, disaggregating their own roles and responsibilities, and finding alternative mechanisms for patients to gain access to high-cost medicines (which can be a means to both prevent and manage cognitive dissonance).