50 Million Americans Live in Counties Without Radiation Oncology Sites

More than 50 million Americans live in counties without a radiation oncology practice site, according to an analysis of sites operating between 2018 and 2025. Hundreds of counties saw declines in services during the period. Losses were greater in rural communities and among independent centers without hospital affiliations.

Radiation therapy is used in more than half of cancer cases and often requires daily visits over several weeks. Rural sites closed at higher rates than urban facilities. Counties that lost sites were more likely to have lower incomes, higher uninsured rates, and fewer primary care physicians.

Urban counties typically retained multiple options after a closure; many rural counties lost their only local site.

A radiation oncologist at the Icahn School of Medicine at Mount Sinai said rural and freestanding sites disappeared at much higher rates than their counterparts. The same physician noted that non-hospital-affiliated centers may lack institutional support to absorb financial shocks.

Data collection ended before 2026 Medicare reimbursement changes took effect. An industry group said the findings reflect conditions before those payment reductions began. The physician stated that payment policies should better reflect how modern radiation therapy is delivered and provide greater financial predictability.

The analysis should be viewed as a baseline rather than a complete picture of current risk, the physician added.