Oncology care access across the US is at risk, particularly for patients living in rural areas, according to a new report from the American Society of Clinical Oncology (ASCO).

Access to care is likely to become more limited, the report found, because patient demand is growing as the number of available oncologists is poised to decline outside of metropolitan areas — with much of the current workforce nearing retirement.

The report, published in JCO Oncology Practice, offers an important glimpse into the future of cancer care, said coauthor Manali I. Patel, MD, MPH, immediate past chair of ASCO’s Health Services Research Committee.

“We’re seeing a convergence of factors: A growing older population and a projected increase in cancer cases are putting pressure on an unevenly distributed oncology workforce,” Patel stated in an ASCO press release. “Our data identifies significant ‘cancer care deserts,’ particularly in rural communities, where 11% of older Americans live without a practicing oncologist.”

Coauthor David Chism, MD, has worked in several rural communities in eastern Tennessee and seen firsthand the challenges posed by a dwindling oncology workforce.

“Many patients in these regions have limited resources, making it difficult for them to travel long distances or take time away from work,” Chism, of Tennessee Oncology, Nashville, Tennessee, told Medscape Medical News. He noted that the increasingly complex nature of cancer treatment — particularly the expanding use of novel immunotherapies — compounds the problem.

Based on Medicare billing data and trends at the national, state, and county levels, the investigators found that although the number of oncologists increased between 2014 and 2024 (from 12,267 to 14,547), the number per 100,000 population aged 55 years and older decreased from 15.9 to 14.9.

In 2024, 38 states had fewer oncologists per capita than in 2014, and most of those states faced limited rural workforce coverage.

Further, although 89% of Americans lived in counties with practicing oncologists, 68% lived in areas where at least 25% of those oncologists were nearing retirement age. Meanwhile, early-career oncologists were half as likely as later-career oncologists to work in rural areas or areas with high cancer risk — including above-average rates of cancer mortality, smoking, obesity, social vulnerability, lack of insurance, and lack of broadband internet access.

In fact, by 2037, nonmetropolitan areas are projected to meet less than one third of their demand for medical and hematology oncologists. Conversely, metropolitan areas are projected to fully meet their demand, the investigators said.

These findings are striking, they noted, given that new cancer cases in North America are projected to increase 56% by 2050 — highlighting the pressure this could place on an already strained workforce.

For its part, ASCO said it “will continue to monitor national and local developments in the oncology workforce” and will look to these findings to inform gaps in cancer care, including advocating for policy solutions.

As Patel put it, the findings underscore a “growing need for proactive solutions — like incentivizing practice in underserved areas and expanding telehealth — to help ensure that geography doesn’t limit a person’s access to quality cancer care.”

Chism agreed. “ Without national and state incentives — for example, medical school loan forgiveness — these communities are particularly vulnerable,” he said. 

Sharon Worcester, MA, is an award-winning medical journalist based in Birmingham, Alabama, writing for Medscape Medical News, MDedge, and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and healthcare topics. She can be reached at sworcester@mdedge.com or on X @SW MedReporter.