This study examined predictors of radiation oncology (RO) practice-site disappearance across the US from 2018–2025 using CMS data, and compared sociodemographic/health system features of counties with versus without RO access in 2025.
Freestanding sites had 56% higher odds of disappearance vs. hospital-affiliated sites (OR 1.56; 95% CI 1.24–1.95), and rural sites had 44% higher odds vs. urban (OR 1.44; 95% CI 1.23–1.69). Net site loss occurred in 13.6% of counties (427/3,144); 68.5% of counties (2,154/3,144), home to 50.8 million people, had no RO site in 2025—counties with disproportionately higher poverty, uninsurance, and fewer primary care physicians.
Administrative claims data (CMS National Downloadable File) may not fully capture all active RO sites or site mergers; study reflects site presence, not actual patient access or travel burden; causal inference is limited by observational design.
Freestanding and rural RO sites are at the highest risk of closure — clinicians and health systems should advocate for policies that stabilize these practices. Over 50 million Americans already live in counties without any RO site, concentrated in socioeconomically vulnerable communities.
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