Radiation oncology clinics are disappearing from rural and community-based settings, suggest findings published July 9 in the International Journal of Radiation Oncology • Biology • Physics.
Over two-thirds of all U.S. counties representing nearly 51 million people don’t have a radiation oncology practice site in 2025, wrote a team led by Catherine Yu, MD, from the Icahn School of Medicine at Mount Sinai in New York.
“The large, socioeconomically vulnerable population currently residing in counties without radiation oncology access underscores the need for policies that strengthen practice resilience in structurally high-risk communities,” Yu and colleagues wrote.
County-level net change in radiation oncology practice sites from first appearance through 2025.ASTRO
Using data collected between 2018 and 2025 from the Centers for Medicare & Medicaid Services (CMS), the researchers identified vulnerabilities in the U.S. cancer care infrastructure as community-based and rural radiation oncology practices close.
They reported the following findings:
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68.5% of all U.S. counties, representing 50.8 million people, do not have a radiation oncology practice site in 2025.
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427 U.S. counties experienced a net loss of radiation oncology practice sites during the study period.
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Rural sites had 44% higher odds of disappearance than urban sites, and freestanding sites had 56% higher odds of closing than hospital-affiliated sites.
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County-level net loss of sites occurred in 13.6%. of counties. Among loss counties, urban areas retained an average of 3.66 sites by 2025 compared to 0.43 and 0.28 sites in rural-adjacent and rural-nonadjacent counties, respectively.
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People in counties without radiation oncology access were more likely to face lower incomes, higher uninsurance rates, and fewer primary care physicians per capita than counties with at least one practice site.
The American Society for Radiation Oncology (ASTRO), the journal’s publisher, highlighted that these trends point toward the need for the Radiation Oncology Case Rate (ROCR) Act, which would move Medicare toward a more stable, patient-centered payment model based on each patient’s episode of care, rather than the number of radiation therapy treatments delivered
“The findings are particularly concerning because they reflect conditions before the Medicare radiation oncology reimbursement crisis began in 2026,” said ASTRO CEO Vivek Kavadi, MD. “Community-based and rural practices were already vulnerable before the current emergency. Without action, today’s payment instability could accelerate the loss of local cancer care infrastructure in the communities least able to absorb it.”
Kavadi added that the findings reflect reflect conditions before the Medicare radiation oncology reimbursement shortfall began in 2026.
“Community-based and rural practices were already vulnerable before the current emergency,” he said. “Without action, today’s payment instability could accelerate the loss of local cancer care infrastructure in the communities least able to absorb it.”
Read the full study here.
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