OBJECTIVE: Chemotherapy-induced anemia is a concern in oncology patients. The objective of this study was to assess patterns of treatment with erythropoietic therapy among oncology patients in a managed care setting, and compare with the National Comprehensive Cancer Network (NCCN) cancer and treatment-related anemia clinical practice guideline recommendations. METHODS: Members of a health plan who received chemotherapy and erythropoietin and had access to laboratory result data between 1/1/2000 and 2/28/2002 were included. Data were analyzed to examine factors that were significantly associated with use of erythropoietic therapy stratified by nadir hemoglobin categories. RESULTS: A total of 2,560 patients were identified. Erythropoietic therapy was initiated in 615 (45%) patients whose hemoglobin dropped below 12g/dL, 443 (52%) patients whose hemoglobin dropped below 11g/dL (NCCN hemoglobin level to consider erythropoietic therapy), and 275 (62.5%) patients whose hemoglobin dropped below 10g/dL (NCCN hemoglobin level to strongly consider erythropoietic therapy). Multivariate analysis revealed that the mean probability of receiving erythropoietic therapy was 0.34 (95% CI; 0.27-0.42) for patients whose hemoglobin fell between 10.5g/dL and 10.9g/dL; 0.44 (0.36-0.53) for patients who reached a low between 10.0g/dL and 10.4g/dL; and 0.67 (0.61-0.72) for patients who dropped below 10.0g/dL controlling for cancer type, blood administration, filgrastim and select chemotherapeutic usage, hypertension and diagnosis of anemia. Patients who received erythropoietic therapy were initiated following a mean adjusted hemoglobin of 10.4g/dL (10.3g/dL-10.6g/dL). CONCLUSIONS: These data suggest a treatment gap in patients whose hemoglobin levels drop below thresholds set by the NCCN guidelines.