Barrett and Zon: Lessons in Leadership, Challenges in Cancer Care

When it comes to cancer care in the United States, women are taking the lead: Nadine Barrett, PhD, MS, MPH, today concludes her yearlong term as president of the Association of Cancer Care Centers (ACCC), while Robin Zon, MD, FACP, FASCO, serves as president of the American Society of Clinical Oncology (ASCO), the largest organization for cancer professionals.

Nadine Barrett, PhD, MS, MPH | Image: Wake Forest

Robin Zon, MD, FACP, FASCO | Image: ASCO

The idea that women would lead both organizations (a third, Debra Patt, MD, PhD, MBA, became president of the Community Oncology Alliance in January), is less unthinkable than it might have been years ago. Yet for both Barrett and Zon, Thursday still offered a chance to share lessons in leadership and the future of cancer care, which the 2 have gathered over decades working on the front lines, building teams, and learning to balance their roles as professionals, family members, and caregivers.

Barrett and Zon shared their insights during a question-and-answer session at the ACCC 51st Annual Meeting & Cancer Center Business Summit, in Washington, DC. The session was moderated by ACCC Executive Director Meagan O’Neill, MS.

Barrett is senior associate dean for research equity and community engagement in the School of Medicine at Wake Forest School of Medicine and Atrium Health, the third-largest nonprofit academic health center in the country. Zon is now a physician emeritus at Michiana Hematology-Oncology, PC, where she previously served as president/CEO, and works with a nonprofit that offers free telehealth second opinions for patients with breast cancer. O’Neill asked both to discuss how they balance their many hats.

Barrett supervises multiple teams, and she said she’s very careful about who she hires. There may be multiple candidates who could perform a job, she said, but it’s a matter of “also recognizing what is it that they have that I'm missing, and the rest of the team is missing, and not just in terms of their tactical skills, but also emotional intelligence—the ability to be able to interact and engage with people in a meaningful way.”

Her role is to find good people and trust them to do their job. “I see my role really as being able to support them in being their best when they're their best, and we have a shared vision.”

Zon agreed but added that people must also have the authority to act. “Delegation and trust are important…having expertise is critically important,” she said. “But also in those teams, I feel it’s important that we help them develop, both professionally as well as personally—so they have a goal. They want to stay.”

Leadership training is important, Zon said, and she credits ASCO for offering opportunities. When she was starting out, “There wasn’t a lot for women,” she said. “It was really the school of hard knocks.”

However, she had had mentor at her first job—a chemist at Dow Chemical—who showed her that a woman could be a professional and still have a family. She credited male mentors who told her if she wanted to be an oncologist, she’d have to learn how to run a business. Barrett said she’s been aided by teams who help her break down her “vision” and ideas at “1000 feet” to more actionable items.

O’Neill asked each to comment on how mentors had shaped their careers—and how they viewed their own roles as mentors. Barrett said she had an “amazing” mentor who opened doors for her at the undergraduate level by getting her a meeting that led to a scholarship, which helped Barrett start graduate school.

“Honestly, I had no idea what the possibilities [were], because I'm the first person in my family to actually go through a bachelor's degree and then move on from a bachelor's to a master's, and doctorate,” Barrett said. “So, for me, it was all very new.”

Zon said, she, too, was the first in her family to attend school beyond college; when she was growing up, “Women didn’t go into the sciences; when I was in high school, I was one of the few that actually went to college.”

Her mentor at Dow Chemical not only offered a role model, but also shared “what I should expect as I move on throughout my journey, and the challenges I might face and how to encounter them.” Fellowship advisers and ASCO leaders also served as early mentors, she said, and even patients have given her excellent advice.

Barrett finds that the mentor relationship today can work both ways, as she described relationships with community partners and faith leaders. “They will pray for me or send me a text message,” she said. “They completely give me guidance, and remind me, as my mother said, pull people into peace; don’t join them in chaos.”

When it comes to being a mentor, Zon said, “I think about being affable, able, and available.” Barrett said commitment matters, and “It’s important to know the difference between self-appointed mentors, and people who are actually mentors. There is a difference.”

Presidential Themes

O’Neill asked Barrett and Zon to discuss their presidential themes; for Zon, it is “Driving Knowledge to Action: Building a Better Future,” which focuses on turning research into tangible change.

Zon said this theme draws on her experience in community oncology, which has taught her that, “You can’t conquer cancer unless you’re actually applying it.”

That means bringing all the knowledge gained through clinical research and bringing it out to patients, which involves the use of technology, whether it’s artificial intelligence (AI) to speed precision medicine or telehealth to offer more patient access. Zon is a proponent of telehealth and its promise of giving patients higher-level expertise and second opinions, although, as she answered later on, she knows that oncology must have guardrails regarding transparency, patient privacy, medical liability, and protections for AI hallucinations, which are misleading or incorrection results.

Barrett’s theme, “Reimagining Community Engagement and Equity in Cancer,” has focused on leveraging community expertise to build trustworthiness to advance equity in research and cancer care outcomes. She said that when health systems think about the communities they serve, it’s important to think about who is missing—who is not being served. Her year at the helm has also seen engagement on the topic of palliative care.

Trustworthiness keeps coming up. “People always ask me over my many years now in this space, how do we build trust in the community,” Barrett said, noting that journals repeatedly cite trust as the top reason for disparities in health care and in recruiting for clinical trials.

“But I actually say, ‘Do we really need to build trust in the community, or do we as institutions or organizations need to become more trustworthy?’ If we become more trustworthy, we will earn the trust. This also allows us to look at ourselves, as opposed to saying, ‘How do we fix the community so that they can trust us,’ and that it gives no room, or limited room for self-reflection of what we need to do differently.”

O’Neill asked both leaders to describe the biggest barriers to overcome in oncology, starting with policy. Barrett was not shy: she went straight to the current efforts within the National Institutes of Health to restrict the percentage of research grants that can cover indirect costs. Research, she said, is what has elevated the standard of care in cancer over the past several decades. “Because of clinical trials,” she said, “People are seeing their children get married, seeing their children graduate from high school and college. Because of research—and that's standard of care.”

Cutting into funding research costs will have a negative impact on the standard of care, and that’s depressing to think about, Barrett said. “To me, when I see this direct assault on research, it's a direct assault on every last one of us. It's a direct assault on our patients, our communities, and our mission. Our mission is to help people to live the longest life possible. That's the definition of health equity.”

“Thank you for addressing the research arm,” Zon said in response. “As community physicians, we understand the importance; we all have those stories of individuals who even back in 1990 were diagnosed with breast cancer stage IV who are still alive. How does that happen?”

Again, Zon said, telehealth can’t provide all the answers, but “it is the key to success in many ways.” She called for policies that continued to support this mode of care delivery; Medicare is scheduled to stop reimbursing most telemedicine services on March 31, 2025, without action by Congress.

As ASCO president, Zon said she’s made it a priority to visit each state to understand the local policy nuances, because so much of what happens from a reimbursement and care delivery standpoint is affected by state policy. “The empowerment of the states is very important, because at the end of the day, we have the federal rules, but the law is actually administered at the state level. They know what the needs are.”

Both Zon and Barrett were asked for a call to action. Barrett called on organizations to respect the current challenges in addressing health disparities but to continue to address them, while ensuring that everyone has access “to the best cancer care possible.”

Zon, noting the diversity of the ACCC membership, called for everyone to keep focused on the need to conquer cancer. “We come in with different goals that we're asked to achieve, to be able to achieve that mission. And the issue is that those goals don't always align with each other, and sometimes it actually causes conflict. So my very bold call to action is to acknowledge that we may share the mission, but we may have goals that are conflicting with each other, and perhaps what we need to do is step back and take a look at how can we… better align those goals so we still be successful.”

Barrett concurred with this idea. “Cancer is a team sport—it really is,” she said. “It takes all of our struggles within our organizations, across our organizations, to create the kind of change that is needed.”