A groundbreaking study published in the International Journal of Radiation Oncology • Biology • Physics reveals a troubling decline in the availability of radiation oncology treatment sites across the United States, with over 50 million Americans now residing in counties without access to these vital cancer care facilities. The research, led by Dr. Kunal K. Sindhu and colleagues, presents a comprehensive county-level analysis of the net change in radiation oncology practice sites between 2018 and 2025, highlighting a disproportionate loss in rural and community-based environments.
Radiation therapy is a cornerstone in oncologic treatment, utilized in more than half of all cancer cases. The therapy typically requires patients to attend multiple sessions over an extended period, making geographic accessibility a critical factor in treatment adherence and outcomes. The study’s findings underscore the severe disparity in care access: while urban areas that lost facilities often maintained multiple alternatives, rural counties frequently faced the complete loss of local radiation treatment options.
The analysis quantified that 68.5% of U.S. counties lacked a radiation oncology site by 2025, affecting approximately 50.8 million people. Furthermore, 427 counties experienced a net site loss during the study period. Statistical modeling revealed rural practice sites had a 44% higher likelihood of closure than their urban counterparts, and freestanding, community-based centers were 56% more likely to shutter compared to hospital-affiliated facilities. These vulnerabilities manifest against a backdrop of socioeconomic challenges; counties without radiation oncology access typically report lower median incomes, higher uninsured rates, and fewer primary care physicians per capita.
Exacerbating the crisis are the steep Medicare reimbursement cuts implemented in 2026, which were not reflected in the current data but threaten to deepen the financial instability of community-based practices. The payment reductions jeopardize the sustainability of freestanding oncology centers, force closures, and further restrict cancer treatment access in already underserved areas. This financial pressure underscores the urgent necessity for targeted policy intervention to stabilize and safeguard oncology infrastructure.
Experts emphasize that these closures carry profound consequences beyond mere inconvenience. Previous research correlates increased distance to radiation therapy facilities with elevated cancer mortality, signifying that diminished local access translates directly into poorer patient survival rates. “When a rural community loses a radiation oncology clinic, patients may lose local access entirely, compounding hardship during an already difficult diagnosis,” said Dr. Sindhu.
ASTRO, the American Society for Radiation Oncology, is advocating for reform through legislative proposals such as the Radiation Oncology Case Rate (ROCR) Act, which aims to shift Medicare reimbursement toward a patient-centered, episode-based payment system. Such reforms seek to mitigate financial strain on clinics, particularly in vulnerable rural and community settings, aiming to preserve critical access for patients nationwide.
The study not only documents the ongoing erosion of the United States’ radiation oncology delivery system but also serves as a clarion call for systemic change. Without urgent policy solutions, cancer patients in rural and economically disadvantaged areas risk losing life-saving therapy, underscoring the intersection of healthcare access, socioeconomic inequity, and health outcomes in modern oncology.
Subject of Research: Structural Vulnerability in Radiation Oncology Access in the U.S.
Article Title: Structural Vulnerability in the United States Radiation Oncology Delivery System: Predictors and Consequences of Practice Site Disappearance
News Publication Date: July 9, 2026
Web References: https://www.redjournal.org/article/S0360-3016(26)03986-6/fulltext
Image Credits: International Journal of Radiation Oncology • Biology • Physics (Red Journal)
Keywords: Radiation therapy, cancer treatment access, healthcare disparities, rural health, oncology practice closures, Medicare reimbursement, healthcare policy
