The concept of the lead cancer nurse is relatively new; no models of practice are available. An evaluation of lead cancer nurses was undertaken to identify core elements of success associated with this role. A two-stage multiple case study was used. In stage one, information was collected about post holders, working contexts, strategic aims and evidence of achievements from lead nurses, lead clinicians and senior nurses. Stage two explored the processes that enhanced and inhibited development of the lead nurse role. Site-visits were made to 12 Macmillan lead cancer nurses throughout the UK. Detailed information from interviews, observations and documentary materials were analysed using a framework that emphasized four key areas: assessment of current service, promotion of evidence-based practice, contribution to strategic decision making and consumer perspectives. Results: Enhancing factors important to the lead cancer nurses were the ability to: utilize decision-making power, build alliances and accommodate to a changing environment. Factors found to hinder achievement were: major changes in service and policy, restricted resources and the cancer site-specific structure of health service provisions. Further and greater contributions to cancer care from lead nurses require influential partnerships within local health care organizations and wider networks.