Cancer agencies within Canada operate with a variety of leadership models, assuming that future leaders are identified, developed and supported by institutions other than their own. A literature review, comprehensive survey and structured interviews were conducted to illuminate the perceptions of leadership in Canadian cancer centres. The major finding from the study is the significant gap between the competencies that leaders acknowledge as being important and the lack of development programs for future and current leaders. The study also showed there is agreement on preferred leadership models and the personal traits that identify future leaders worthy of development. Given the current struggles of leadership, the authors suggest that cancer agencies need to strategize how to advance succession planning and leadership development frameworks.