More than eight in 10 areas need to improve if England is going to meet its ambitious target of developing "world class" cancer care by 2020, according to an analysis by NHS bosses.
The NHS England review looked at how all 209 local health boards - called clinical commissioning groups - were performing on waiting times, cancer survival, patient surveys and early diagnosis.
Only 29 were classed as performing well enough to meet the ambitions set out in the 2015 cancer plan.
That called for improvements in care so that by 2020 another 30,000 lives per year could be saved.
Dr Fran Woodard, of Macmillan Cancer Support, said the review was "very concerning".
"It highlights just how much the NHS is struggling to meet the challenge of delivering cancer services which meet all the critical needs of people with cancer."
The findings show that two-thirds of areas are failing to achieve the target of ensuring 85% of cancer patients start treatment within 62 days of an urgent referral.
More than half are not seeing 70% of cancer patients survive for a year - another stated ambition.
But a spokeswoman for NHS England defended the performance of the local health groups.
"Cancer care is now the best it's ever been, but we've set stretching goals to save thousands more lives by 2020.
"Measured against this ambition it's not surprising that most local services need to make further improvements, but we're going to track progress transparently so everyone can see how we are improving care and outcomes for patients."
The data will now be used by cancer alliances which will work across regions to help drive up performance between now and 2020.