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Background: The cancer burden in northeast India is high, with low survival and low case detection. Despite the availability of cancer institutes in the region, existing literature remarks on the increasing travel outside the region for cancer care. However, research is sparse on identifying impediment factors to the access of state cancer institutes., Objective: To examine the barriers to cancer care in five common cancer sites: oral, lungs, stomach, breast and cervix., Method: Following a descriptive multiple-embedded case study design integrating quantitative and qualitative approaches, 388 participants were selected in phase one by stratified random sampling. In phase two, by purposive sampling, 21 semi-structured interviews were conducted., Result: The result suggests that family decision is the central factor in cancer care access. Treatment initiation is delayed because the existing government health insurance scheme does not cover diagnostic tests. Adverse steps are taken to fund cancer treatment. Besides, opting for alternative medicines were due to fear of surgery, chemotherapy and recommendations by relatives. Arranging accommodation, transportation and infrastructure shortage was another hurdle. In contrast, the lack of awareness of the state cancer institutes was a barrier to its access., Conclusion: This paper identifies and describes factors that hinder access to state cancer institutes. The findings could enhance policy interventions for efficient cancer care access in the region. Integration with NGOs working at the state level for cancer services would support ease of access by providing funds for diagnostic tests, accommodation and transportation, especially for those who cannot afford it., (© 2023 John Wiley & Sons Ltd.)