This article originally appeared on Newsweek. Read more here.
A cancer diagnosis can turn life upside down. But for a growing number of Americans, one of the biggest challenges may be getting to treatment in the first place.
New research published in the International Journal of Radiation Oncology*Biology*Physics (also known as the Red Journal) suggests access to radiation therapy—one of the most commonly used cancer treatments in the U.S.—has been shrinking across hundreds of counties, with rural communities facing the greatest losses.
The study found that more than 50 million Americans now live in counties without a radiation oncology practice site. Researchers say the concern is not only the number itself but what happens when treatment disappears from areas that already have limited healthcare resources.
In cities, the closure of a radiation clinic may mean patients need to travel farther. In rural communities, the loss of a single facility can eliminate local access altogether.
That pattern emerged in an analysis of radiation oncology practice sites operating between 2018 and 2025. During that period, hundreds of counties experienced declines in radiation oncology services, with losses concentrated in communities that had fewer healthcare options to begin with.
Radiation therapy is used in more than half of cancer cases and often requires daily treatment over several weeks. As a result, travel distance can become a major burden.
Researchers found that rural treatment sites were significantly more likely to close than urban facilities. Independent community-based centers were also more likely to disappear than hospital-affiliated sites, suggesting smaller providers face greater challenges remaining operational.
Although the study was not designed to determine why specific clinics closed, senior author Dr. Kunal K. Sindhu, a radiation oncologist at the Icahn School of Medicine at Mount Sinai, said the pattern was clear.
“Our data do show a consistent pattern in that rural sites and freestanding sites lacking hospital affiliations disappeared at much higher rates than their counterparts,” he told Newsweek.
According to Sindhu, non-hospital-affiliated centers may lack the institutional support needed to absorb financial and operational disruptions that larger health systems can withstand. Rural practices often operate in communities with longstanding healthcare infrastructure challenges, leaving them especially vulnerable to financial shocks.
“The burden of radiation oncology site loss falls especially hard on rural communities,” Sindhu said.
“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 counties losing treatment access often shared other disadvantages. They were more likely to have lower incomes, higher rates of uninsured residents and fewer primary care physicians.
“Hundreds of counties experienced a decline in radiation therapy access, but what’s most concerning is where those losses occurred,” Sindhu said. “The communities most vulnerable to losing radiation oncology access are often the same communities that already have fewer healthcare resources.”
The closures were geographically dispersed rather than concentrated in any one state or region, pointing to a broader national vulnerability. Sindhu noted that many U.S. counties already lacked radiation oncology practice sites before the closures identified in the study.
The impact of losing a treatment center also differed sharply by location. Urban counties generally retained several treatment options after a closure, while rural counties often depended on a single site. When that facility closed, residents frequently lost local access to radiation therapy altogether.
Those barriers may have serious consequences. While the study did not examine patient outcomes directly, Sindhu pointed to previous research linking longer travel distances for radiation treatment to worse outcomes, including higher mortality.
When local clinics disappear, patients may face longer commutes, higher costs and disruptions to work and family responsibilities.
“These burdens can potentially influence whether a patient initiates, completes, or is even offered guideline-concordant treatment,” Sindhu said. “In rural counties, where a single practice site often represents the only local treatment facility, that effect may be most pronounced.”
Researchers say the situation could become even more challenging. The study’s data ended before major Medicare reimbursement changes took effect in 2026, meaning the analysis does not capture the financial pressures many radiation oncology providers now face.
According to Sindhu, reimbursement remains central to the discussion. Changes introduced by the Centers for Medicare & Medicaid Services (CMS) in 2026 resulted in substantial payment reductions for many radiation oncology practices.
ASTRO CEO Dr. Vivek S. Kavadi said the findings are particularly concerning because they reflect conditions before those reimbursement cuts began.
“Every patient with cancer deserves access to high-quality radiation therapy close to home, but this study underscores how deeply policymakers’ decisions can shape a person’s ability to receive care,” Kavadi said.
“The findings are particularly concerning because they reflect conditions before the Medicare radiation oncology reimbursement crisis began in 2026. Community-based and rural practices were already vulnerable before the current emergency.”
Looking ahead, Sindhu said the priority should be preventing further erosion of the nation’s radiation oncology network by addressing the financial pressures facing providers. Over the longer term, he argued that payment policies should better reflect how modern radiation therapy is delivered while providing greater financial predictability.
He pointed to the bipartisan Radiation Oncology Case Rate (ROCR) Act currently before Congress as a potential pathway toward a more stable reimbursement system.
“Given that our data predate the 2026 Medicare reimbursement changes, this analysis should be read as a floor, rather than a full accounting of current risk,” Sindhu said.
Reference
Sindhu, K., Yu, C., et al. (2026) Structural Vulnerability in the United States Radiation Oncology Delivery System: Predictors and Consequences of Practice Site Disappearance, International Journal of Radiation Oncology*Biology*Physics http://dx.doi.org/10.1016/j.ijrobp.2026.06.3090
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