More than 50 million Americans lived in U.S. counties without a radiation oncology practice site in 2025, according to a national study published in the International Journal of Radiation Oncology • Biology • Physics.
Researchers found that 68.5% of U.S. counties, representing 50.8 million people, had no radiation oncology clinic. Between 2018 and 2025, 427 counties experienced a net loss of radiation oncology practice sites, with rural and freestanding community-based facilities more likely to close than urban or hospital-affiliated sites.
The analysis found rural sites had 44% higher odds of disappearing than urban sites, while freestanding sites had 56% higher odds of closing than hospital-affiliated locations. In many urban counties, the loss of a clinic still left patients with other local treatment options. In rural counties, however, closures often eliminated local radiation therapy capacity altogether.
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Researchers also reported that counties without radiation oncology practices were more likely to have lower household incomes, higher uninsured rates and fewer primary care physicians per capita than counties with at least one practice site.
Radiation therapy is used in more than half of cancer cases, and treatment often requires multiple visits over several weeks. Previous research has linked longer travel distances for radiation therapy with worse cancer outcomes.
“The burden of radiation oncology site loss falls especially hard on rural communities,” said Kunal K. Sindhu, M.D., senior author of the study and a radiation oncologist at the Icahn School of Medicine at Mount Sinai. “When a rural community loses a single radiation oncology practice, patients may lose local access entirely. For someone already coping with a cancer diagnosis, that can mean added strain at a time when care should be as accessible as possible.”
The study examined data through 2025 and therefore did not capture the effects of Medicare reimbursement changes that took effect in 2026. The authors noted those payment changes could place additional financial pressure on practices that were already vulnerable, particularly freestanding and rural facilities.
