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Introduction The COVID-19 pandemic spurred telehealth use in US oncological care but there remains limited data on the onco-primary cancer survivorship population. We investigated patterns of telehealth use during the pandemic and factors driving utilization.Methods and Materials Retrospective study of patients aged 21 years and older diagnosed with breast, colorectal, prostate or non-small lung cancer (stages 1–4). The study period evaluated was defined as during COVID-19: March 1, 2020–April 30, 2021. Patient cohorts were defined as “ever telehealth users” and “never telehealth users”. We tested between-cohort differences in baseline characteristics using Pearson's chi-square tests.Results We identified 4931 onco-primary patients. Of these patients 36.7% (n= 1812) were “ever cancer telehealth users” and 63.3% (n = 3119) patients were “never cancer telehealth users.” Among telehealth users, 44.6% were 65 years or older at cancer diagnosis, 24% were Black, 24.1% lived in rural settings and the most common cancer types were breast (40.4%) followed by prostate (30.4%). “Never telehealth user” had similar demographics. Increased telehealth use was seen in those patients with a higher baseline comorbidity burden (RR 1.14; 95% CI 1.06–1.23), prostate cancer (Prostate RR 1.33; 95% CI 1.16–1.54) and advanced stage cancer (RR 1.20; 95% CI 1.08–1.34).Conclusion Telehealth, while not as heavily utilized, remains an important care tool in marginalized rural and Black onco-primary care patients.Implications for Practice This paper highlights baseline use rates of telehealth in the onco-primary patients including more health disparate populations and helps guides future healthcare system investments in this technology.