David Wazer, Professor and Chairman of Radiation Oncology at Brown University Health, shared a post on LinkedIn:
“A Looming Collapse: Radiation Oncology’s Access Crisis Is No Longer Theoretical
For years, warnings about the fragility of America’s radiation oncology infrastructure were dismissed as speculation. The study by Yu et al (citation below) makes one thing abundantly clear: the crisis has arrived.
The most alarming finding is not that practice sites are disappearing – it is that the apparent stability of the national system is an illusion. Beneath reassuring national counts lies relentless churn, with freestanding centers 56% more likely to disappear than hospital-affiliated facilities and rural practices facing a 44% greater risk of closure. These are not random losses. They are systematic, predictable, and concentrated precisely where patients have the fewest alternatives.
The consequences are staggering. More than two-thirds of U.S. counties now have no radiation oncology practice site, leaving over 50 million Americans without local access to one of the fundamental pillars of cancer treatment. In rural counties that lose a practice, there is often nothing left – an average of only 0.28 remaining centers compared with 3.66 in urban communities. For patients requiring daily treatments over several weeks, these closures translate into impossible travel burdens, delayed therapy, and potentially compromised outcomes.
Perhaps most disturbing is the timing. These data largely precede the profound Medicare reimbursement disruptions introduced in 2026. If the delivery system exhibited this degree of structural vulnerability before the latest payment changes, one must ask what lies ahead. Without meaningful policy intervention, today’s warning signs may become tomorrow’s collapse.
This paper should serve as a wake-up call for policymakers, ASTRO, and every stakeholder in oncology. The issue is no longer simply reimbursement or practice economics. It is whether the United States is willing to tolerate the slow dismantling of equitable access to life-saving cancer care. If these trends continue unchecked, future generations may look back on this moment not as the beginning of the crisis – but as the moment we failed to stop it.”
Title: Structural Vulnerability in the United States Radiation Oncology Delivery System: Predictors and Consequences of Practice Site Disappearance
Authors: Catherine Yu, Sifan Grace Lu, Danielle Arons, Jared P. Rowley, Kunal K. Sindhu
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