Radiation oncology treatment facilities are quietly disappearing across the United States, leaving more than 50 million people without a local medical facility, according to a new national survey.
Study: Structural Weaknesses of the U.S. Radiation Oncology Treatment System: Predictors and Consequences of Clinic Disappearance. Image credit: SGr/Shutterstock.com
New research published in International Journal of Radiation Oncology · Biology · Physics Radiation oncology treatment facilities are disappearing disproportionately across the United States, with more than 50 million Americans without a local medical facility, stable national statistics show.
Financial pressures threaten local radiology services
Over the past decade, the United States has faced increasing concerns about the stability, integration, and geographic uneven distribution of radiation oncology services, particularly in rural and socioeconomically disadvantaged areas.
Recent evidence highlights significant changes in the healthcare delivery system, with radiation oncologists and physicians becoming integrated within fewer and larger organizations. Research examining practice integration and employment patterns at the organizational level shows how radiation oncologists have changed the organizations and hospitals in which they work and how corporate structures have evolved over time.
These insights give an overall impression of the organizational stability within the radiation oncology workforce, but at the same time raise questions about the stability of the individual treatment facilities where patients actually receive radiation therapy on a daily basis.
Establishing and functioning a radiation oncology clinic requires significant financial investment, regulatory approval, and professional staffing. Because of these requirements, individual clinics may respond to different financial, operational, and policy pressures than the organization that owns the clinic. This sustained administrative or financial pressure could potentially lead to the disappearance of clinics, thereby disproportionately impacting local treatment capacity in rural areas and socioeconomically disadvantaged populations.
Given the importance of understanding individual clinic-level dynamics, researchers at the Icahn School of Medicine at Mount Sinai systematically analyzed more than 3,000 individual radiation oncology clinics nationwide using annual data from the Centers for Medicare and Medicaid Services’ National Downloadable File for Physicians and Clinicians collected between 2018 and 2025.
Stable national aggregates hide growing local turnover rates
Study analysis showed that although the total number of radiation oncology clinics in the United States appeared to be generally stable during this period, some individual radiation oncology clinics disappeared from the CMS dataset over time. The authors note that the disappearance of a clinic identified in the administrative dataset does not necessarily indicate a confirmed closure of the clinic.
Specifically, the analysis revealed that rural radiology clinics had a 44% higher probability of disappearance than urban clinics, and independent clinics had a 56% higher probability of disappearance than hospital-affiliated clinics.
Of the 3,144 U.S. counties, 427 had a net loss of radiation oncology clinics between 2018 and 2025. In counties with a net decline, urban areas maintained an average of 3.66 clinics by 2025. However, rural contiguous counties maintain an average of 0.43 clinics, while non-rural noncontiguous counties maintain only 0.28 clinics, indicating that many regions have little or no local treatment capacity left.
Approximately 68.5% of all U.S. counties, representing a population of 50.8 million people, did not have a single radiation oncology clinic in 2025. On average, counties without a radiation oncology clinic have higher poverty and uninsured rates, lower incomes, and fewer primary care physicians than counties with at least one radiation oncology clinic.
The study also found that more than 70% of counties experiencing a net loss of radiation oncology facilities were located in the South and Midwest, highlighting the regional concentration of these changes.
Loss of local hubs could widen disparities in cancer treatment
This study suggests that the apparently stable national totals mask significant attrition rates at individual radiation oncology practices. In particular, the disappearance of clinics is not evenly distributed across the country, with rural clinics and independent clinics facing the most pronounced challenges.
The observed disparities suggest that previously anticipated administrative and financial pressures on freestanding or local radiation oncology clinics are now manifesting as visible practice declines across the national radiation oncology delivery system.
Radiation therapy is a major treatment option for cancer patients and is used in more than 50% of all cancer cases. It is especially important that patients have access to nearby radiology facilities, as treatment often requires multiple visits over several days or weeks. Previous studies have shown that longer travel distances and reduced local availability can contribute to delayed or incomplete treatment, but this study did not directly examine treatment completion or patient survival. This evidence highlights the importance of maintaining local therapeutic capacity in patients requiring repeated radiotherapy.
The loss of one clinic in a metropolitan market is likely to have minimal impact on cancer patients. However, in rural areas where there are few or no alternatives, the disappearance of a clinic may leave the county without a radiation oncology clinic and patients may have to go to a facility in a neighboring county.
As observed in the study, counties without access to radiology clinics are consistently more disadvantaged socioeconomically than counties with at least one radiology clinic, raising concerns that current access disparities may widen further in the absence of future reimbursement reform.
Studies examining strategies to improve health care access point to several institutional strategies to address local health disparities, including opening satellite clinics, expanding telehealth capacity, and building partnerships between health care providers and community leaders.
However, these strategies Radiation oncology relies primarily on in-person, highly technical treatment, employing trained staff, providing regional technical support, and These include coordinated network models, improved patient support infrastructure, and reimbursement approaches that better support structurally weak practices.
Given the seriousness of the current findings, the researchers emphasize the need for future research to investigate how this occurs. Impact of the disappearance of the practice fields Patient outcomes and whether policy changes improve long-term stability.
Administrative data does not allow confirmation of permanent site closure
The authors note several important limitations. This analysis relied on CMS administrative data that collects clinician billing and practice information, rather than directly confirming the operation or closure of radiation therapy facilities. As a result, the disappearance of a clinic from the dataset does not necessarily indicate that the clinic has permanently closed.
Additionally, hospital affiliation data was only available through 2021. The study did not measure differences in treatment capacity such as staffing or number of linear accelerators, county-level socioeconomic data is based on 2021 estimates, and the observational design means the findings identify an association, rather than proving that rural location, independent status, or financial pressures caused the clinics to disappear.
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Reference magazines:
- Yu C. (2026). Structural weaknesses in the U.S. radiation oncology delivery system: Predictors and consequences of clinic disappearance. International Journal of Radiation Oncology, Biology and Physics. Doi: 10.1016/j.ijrobp.2026.06.3090. https://www.redjournal.org/article/S0360-3016(26)03986-6/fulltext
