#ACCCNOC: Insights on Dyad Leadership Models, Bridging Primary Care and Oncology, and Solutions in Rural Oncology

The final day of the 42nd National Oncology Conference (NOC) featured a series of panels that brought together leaders and innovators to discuss aligning clinical and administrative priorities, coordinating oncology and primary care, and addressing challenges faced by rural and remote communities. 

Women Leaders in Oncology: Exploring Successful Dyad Models 

As health care grows more complex, bridging business goals with quality, patient-centered care is essential. To achieve that alignment, more and more health systems are embracing a dyad leadership model, defined by MDA Consulting as “formal leadership partnerships between respected physician leaders and skilled administrators to capitalize on the strengths and attributes of each.” 

Kelley Simpson, MBA, president of Cancer Concierge LLC, moderated a panel discussion to examine how dyad partnerships can foster a shared language, build mutual understanding, and drive quality and process improvement. 

Alyssia Crews, MBA, vice president of Orlando Health, remarked that mutual respect, openness, empathy, emotional intelligence, transparency, and integrity are among the most essential leadership attributes to thrive in a dyad partnership. “I think of yin and yang,” she said. “It’s a dynamic relationship, not a static one.” 

Jennie Crews, MD, MMM, FACCC, FASCO, chief medical officer of Ambulatory Care at Stanford Healthcare and Stanford Medicine Partners, clinical professor of Medicine at the Stanford University School of Medicine, and Interim CEO of Stanford Medicine Partners, agreed—affirming the need to have common core values, and a desire to collaborate and build trust with one another. 

In terms of effective communication styles, the panelists agreed that you can never communicate too much. "As a rule of thumb, I think to myself, ‘What do I know? Who needs to know? Have I told them?’” said Dr. Crews, emphasizing the importance of sharing as opposed to making assumptions. Her dyad includes regular 1-on-1 meetings and continuous communication throughout the day. 

One difficulty that can arise within dyad models is a lack of clear roles and responsibilities among leaders. To avoid this, Crews recommended having the conversation about role delineation as early as possible to avoid overstepping. She did note that today, historical divisions between strictly clinical and strictly administrative responsibilities are fading in favor of a more collaborative model. “We’re both clinical and we’re both administrative,” she said of her dyad model. 

Dr. Crews agreed, commenting on the rising trend of physicians seeking training beyond their medical degrees, such as exposure to business and administration certifications and degrees. “The same is true of administrators,” she said. “Many are coming from a clinical background.”  

The panelists agreed that a lack of effective communication within a dyad model has detrimental effects that trickle down to the rest of the health system. "It becomes clear that we’re not aligned when we try to solve a clinical issue without involving administration, or an administrative issue without involving clinicians,” said Dr. Crews.  

One of the key advantages of partnering these 2 spheres at this level is understanding the “why” behind executive decisions. “Not having transparency and visibility behind decision-making can be frustrating,” Dr. Crews noted. “Being part of the process makes you feel some ownership over these decisions and better equips you to help carry them out and explain them to your teams.” 

As with any leadership model, disagreement and conflict are inevitable. In such cases, Dr. Crews advised talking through issues to find common ground, but not out in the open in front of team members. “Talk through it separately, come to some agreement, and present a united front.”  

Calling back to Susan Salgado’s opening keynote on Day 2, the panelists stressed the importance of maintaining a healthy culture. “If you say you have a strong, positive culture, but you aren’t being genuine, your staff will know,” Crews pointed out. “They will pick up on misalignment. You must stay connected to your purpose and your why, and your behavior has to match what you’re saying. That is what ignites passion and trust in your team.” 

Stronger Together: Building Collaborative Care Models Between Oncology and Primary Care

From prevention and early detection to treatment, survivorship, and long-term monitoring, there are distinct yet complementary roles that oncology and primary care must play to support whole-person health. The second panel of the day shared their insights into building integrated care models that work together across every phase of the cancer journey. 

Cheyenne Corbett, PhD, director of Supportive Care & Survivorship Center and co-director of the Center for Onco-Primary Care at Duke Cancer Institute, began by underscoring the essential nature of ensuring cohesion between oncology and primary care: “Our title isn’t just a theme; it’s a call to action, because the future of cancer care will depend not only on the precision of our treatments, but on the precision of our collaboration. Our focus is on the practical steps that make collaboration real.” 

Dr. Corbett explained that Duke Cancer Institute’s Center for Onco-Primary Care was founded to deliver evidence-based, patient-centered, personalized health care across the cancer continuum, and engages an extensive network of staff across disciplines.  

“Incidence of cancer continues to rise and mortality continues to decline. This progress is extraordinary, but it also means we have millions of survivors,” she stated. “Not every survivor needs the same level of follow-up—that’s where a risk stratified model becomes essential.” This approach makes survivorship sustainable. 

One of the key moments in which patients can be lost to follow-up is during cancer screening and surveillance. For prostate cancer in particular, Duke was experiencing a high volume of referrals, which led to challenges in timely access for many patients. To prevent delays between screening and diagnosis for prostate cancer while managing a high volume of referrals, the team at Duke launched a virtual elevated prostate-specific antigen (PSA) clinic and developed an algorithm to determine which patients were considered low-risk for prostate cancer.  

“From a physician’s perspective, patients who are low-risk do not come with that much urgency clinically. But as a patient hearing that you might have cancer, you want to be seen right away, not in 3 months,” explained Edward Cooner, MD, MBOE, primary care provider, senior medical director of Performance Excellence and chief patient safety officer at Duke Primary Care, Duke Health. “Helping discriminate between the lower risk patients was a huge help in speeding up access and therefore alleviating patient anxiety.” 

Another unmet need for providers was a faster, more reliable way to consult with specialists to see if a patient meets the criteria for a specialty visit. Duke looked to e-consults—asynchronous consultation between peers—to create a streamlined process that ensures specialists only see patients with a clear clinical need, reducing costs for the patient and freeing up specialists to focus on those who need them most. 

"76% of these e-consults were turning into referrals. It was a great success,” said Nilam Patel, MHA, administrative director at the Center for Onco-Primary Care and Supportive Care & Survivorship Center, Duke Cancer Institute. She also shared plans for an e-consult with Duke’s high-risk breast clinic. “We have a lead time issue there, so we want to improve what we can do in the meantime while the patient is waiting to be seen.” 

"We can get that pre-work done in the interim—like a baseline MRI—before the patient is seen, which makes that first visit with the specialist much more valuable," said Dr. Cooner. 

Among the greatest gaps in onco-primary care is addressing comorbidities, such as diabetes and hypertension, during active treatment. In response, Duke built a dashboard to track these patients. "Our providers really appreciate those notifications because they incorporate the PCP into the care team more,” said Dr. Cooner. “We see in primary care that patients tend to slip into a black hole, not focusing on health maintenance items as much during cancer treatment. There becomes a complacency with diseases like hypertension, which really shouldn’t happen.” 

Afreen Shariff, MD, MBBS, endocrinologist, director of Duke’s Onco-Endocrinology Program and associate director of Duke Health’s Cancer Therapy Toxicity Program, agreed, adding that during active therapy, toxicities impact more than just quality of life—they may delay or even stop first-line treatments.  

To address this need, Duke launched the Sugar High Intervention. “For every patient with cancer who has blood sugar over 300mg, my team gets an alert in the EHR,” explained Dr. Shariff. “We review the case and instantly see relevant information to do a quick expert triage.” Such rapid access to specialty care has transformed patient outcomes. Since launching the initiative in December of 2024, Dr. Shariff’s team has received about 500 alerts, 250 unique patients, and added 184 patients to the diabetes registry. 

“Our goal is the same as the oncologists,” she said. “We want to continue patients’ cancer treatment too. And we work together to make that happen.” 

Shared Solutions for Rural Oncology: Insights Across the Americas 

The final session of the day focused on equity in access to cancer care—particularly for patients in rural and remote communities. Beyond their cancer diagnosis, these patients face significant barriers to care, including limited access to oncology specialists, few transportation options, and fragmented care coordination. Recognizing that such challenges extend far beyond national borders, the panel brought together providers from Canada, the United States, and Mexico to share practical strategies for addressing these barriers, helping the global community learn from one another’s experiences and work together toward more equitable cancer care. 

Moderated by Enrique Soto-Perez-de-Celis, MD, PhD, FASCO, associate director for Global Oncology at the University of Colorado Cancer Center, the discussion opened with an exploration of the systemic factors underlying these challenges, such as workforce shortages, delays in the care continuum, and inadequate insurance coverage.   

Jacqueline Galica, PhD, RN, OCN, associate professor at Queen’s University in Canada, shared that despite having a smaller population than the US and Mexico, Canada’s geographical space is huge. Eighty percent of the population is within 95 miles of the American border, while 20% of Canadians live in more northern areas, even as high as the arctic circle. “We talk about not just rurality, but remoteness,” she said. “Spaces where there are little to no infrastructure and no roads in the winter.”  

Distance, therefore, acts as a major barrier to accessing care. “No roads means no physical space to get to chemotherapy or screening, or even access mobile screening,” said Dr. Galica.   

In Mexico, patients experience a highly fragmented health system, according to Yanin Chavarri-Guerra, MD, medical oncologist, full professor of oncology, clinical researcher at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. “Twenty percent of our population lives in rural areas, and of them, about 60% live in extreme poverty,” she said. “They have to travel very far to access cancer care, and fund those housing and travel costs themselves, which just isn’t feasible for many of them.” 

Dr. Chavarri-Guerra also shared the significant delays in care that patients with cancer experience in Mexico. Patients typically go to 2 health care facilities before finally reaching a cancer care facility, with months in between each visit. “Sixty percent of the population is diagnosed at a late stage, and it can take up to 8 months from the first sign of symptoms to the time of diagnosis,” she said. 

In answer to this severe challenge, Dr. Chavarri-Guerra relayed the essential role patient navigators play in assisting patients with paperwork and appointment scheduling to reduce these delays as much as possible. To connect patients with support across vast geographical distances, Dr. Galica commented that mail-in colorectal cancer screening has been highly effective. However, only about 50% of eligible patients pursue it, due to issues like mistrust of the medical system and a lack of health literacy. Dr. Soto commented on the importance of working with native language speakers in outreach and patient education to inspire more confidence in the medical community. 

The panel also touched on the most underserved individuals in rural communities. In Mexico, that primarily includes indigenous women. "They are often caregivers of other family members and have limited access to education," explained Dr. Chavarri-Guerra. Compounded with living far from cancer centers, these individuals tend to go untreated.    

"People living in rural Canada are significantly older than those in urban areas,” commented Dr. Galica. Living alone as an older adult is already a challenge, with factors like eyesight degeneration and loss of a driver’s license that limit travel capability. 

Of strategies that have proven effective, Dr. Galica cited top-down initiatives that are provincially led, such as reminders and mail-ins. She also noted the importance of involving community members in the development of interventions, especially in the case of screening. “When the community was involved in planning—deciding the date, the venue—it dramatically improved the intervention's effectiveness and attendance,” she said. “Partnering with those who have that lived experience is essential.” 

Dr. Chavarri-Guerra also advocated for partnership with community health workers and nurses. "Given the scarcity of oncologists and specialists, we have trained community health workers and nurses in very basic skills like patient education and communication, doing referrals, and providing psychosocial support,” she explained. 

Dr. Soto added that this area is an excellent opportunity to collaborate globally. “In the US, we are fortunate to have highly trained nurses and APPs that can treat patients, but this is not true in other parts of the world,” he stated. 

In closing, the panelists remarked on the practices they believe are most transferrable to rural regions across the Americas. For Dr. Galica, that looks like meaningful engagement with the communities we serve. She emphasized the importance of “working with them, not at them.” 

Dr. Chavarri-Guerra spoke to navigation, and how it can be implemented at any moment throughout the course of cancer care. However, a limitation faced by providers in Mexico is that many navigation programs are pilots. "We need to call on our policymakers to institutionalize these programs,” she urged.  

As ever, NOC would not be the success it is without the engagement, participation, and heart of ACCC’s membership. Thank you to our speakers, poster presenters, and attendees for their commitment to learning, sharing experiences, and working towards more equitable cancer care for all. 

Read the 2 previous blogs for coverage of Day 1 and Day 2of the 42nd National Oncology Conference.