Top Line: Radiation deserts are expanding.
The Study: Using the CMS National Downloadable File, investigators tracked over 3,000 US radiation oncology practice sites from 2018–2025 to identify predictors of site disappearance and characterize downstream effects on geographic access. Despite relatively stable national site counts, there was considerable turnover beneath the surface. Freestanding practices were significantly more likely to disappear than hospital-affiliated sites (OR 1.56), while rural sites also faced higher odds of closure (OR 1.44). County-level analyses painted a stark picture: 427 counties experienced a net loss of radiation oncology clinics, with rural counties often left with no local treatment capacity (0.28–0.43 average remaining sites versus 3.66 in urban counties). By 2025, over two-thirds of all US counties—home to more than 50 million people—had no radiation oncology practice site at all. Unsurprisingly these counties were poorer and more likely to be uninsured and had substantially fewer primary care physicians than counties continuing with radiation oncology access.
TBL: Shifting reimbursement models are likely accelerating a growing rural and socioeconomic divide in access to vital radiation oncology services, with freestanding practices bearing much of the attrition. | Yu, Int J Radiat Oncol Biol Phys 2026
The Study: Using the CMS National Downloadable File, investigators tracked over 3,000 US radiation oncology practice sites from 2018–2025 to identify predictors of site disappearance and characterize downstream effects on geographic access. Despite relatively stable national site counts, there was considerable turnover beneath the surface. Freestanding practices were significantly more likely to disappear than hospital-affiliated sites (OR 1.56), while rural sites also faced higher odds of closure (OR 1.44). County-level analyses painted a stark picture: 427 counties experienced a net loss of radiation oncology clinics, with rural counties often left with no local treatment capacity (0.28–0.43 average remaining sites versus 3.66 in urban counties). By 2025, over two-thirds of all US counties—home to more than 50 million people—had no radiation oncology practice site at all. Unsurprisingly these counties were poorer and more likely to be uninsured and had substantially fewer primary care physicians than counties continuing with radiation oncology access.
TBL: Shifting reimbursement models are likely accelerating a growing rural and socioeconomic divide in access to vital radiation oncology services, with freestanding practices bearing much of the attrition. | Yu, Int J Radiat Oncol Biol Phys 2026