Over 50M Americans live in counties without a radiation oncology clinic
Over 50 million Americans live in counties without a single radiation oncology clinic, with rural geographies hit hardest, according to new research published Thursday.
The findings are based on an analysis of data from the Centers for Medicare & Medicaid Services, spanning 2018 to 2025. Senior author Kunal K. Sindhu, MD, and colleagues sought to identify predictors of radiation oncology practice-site disappearance and how it shapes treatment capacity.
Their analysis—published in the International Journal of Radiation Oncology—comes amid mounting concern about consolidation, instability and poor geographic distribution in RO care. Across the study period, practice sites disproportionately disappeared from rural areas, along with freestanding and community-based settings.
“Hundreds of counties experienced a decline in radiation therapy access, but what’s most concerning is where those losses occurred,” Sindhu, a radiation oncologist with the Icahn School of Medicine at Mount Sinai, New York, said in a statement July 9. “The communities most vulnerable to losing radiation oncology access are often the same communities that already have fewer healthcare resources.”
According to the study, nearly 69% of all U.S. counties, representing 50.8 million Americans, lacked a radiation oncology practice site as of last year. Another 427 counties experienced a net loss of RO practice sites between 2018 and 2025. Rural clinics had approximately 44% higher odds of closing compared to urban ones, while freestanding clinics had 56% greater chances of shuttering compared to their hospital-affiliated counterparts.
Individuals in counties without radiation oncology access were likelier to have a low income, higher insurance rate and fewer primary care docs per capita than those with at least one available practice site. Researchers contend that these findings are alarming, given that they occurred before recent billing code changes took effect this year. The American Society for Radiation Oncology previously shared survey data on these challenges in April, contending the RO profession could be in peril.
“The findings are particularly concerning because they reflect conditions before the Medicare radiation oncology reimbursement crisis began in 2026,” ASTRO CEO Vivek S. Kavadi, MD, MBA, said in the announcement. “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.”
ASTRO said it continues to push for passage of the Radiation Oncology Case Rate (ROCR) Act to prevent further practice closures. Proposed in March 2025, the bipartisan bill seeks to realign the RO specialty so that Medicare pays for the quality of care, rather than the number of times patients visit cancer clinics.
“ROCR is designed to protect access in communities across the country, especially in areas where losing a single clinic can mean patients lose access to radiation therapy that could save their life,” Kavadi added.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.