Background: The COVID-19 pandemic has negatively impacted morbidity, mortality, and economic status globally. Adolescents and young adults (AYAs, age 15-39) with cancer may experience disparities in access to health care, compounded by social distancing and stay-at-home orders aimed at reducing the spread of COVID-19. The use of telehealth platforms for clinical visits has accelerated rapidly due to policy changes during the pandemic. Telehealth may provide an avenue for accessing healthcare services among AYAs with cancer; yet, there are few data on AYAs’ preferences and satisfaction relating to telehealth. Our study examined telehealth utilization, satisfaction, preferences and future recommendations among AYAs with a cancer diagnosis. Methods: AYAs in active cancer treatment or in post-treatment survivorship completed an online questionnaire that assessed their experience with telehealth, including: satisfaction with the telehealth visit, likelihood of participating in a future telehealth visit, topics participants would like to discuss via telehealth, and open-ended comments regarding suggestions for improving future telehealth visits. Participants were recruited in two cohorts: a pre-vaccine cohort (September 2020 - January 2021) prior to availability of COVID-19 vaccines in Texas; and, a post-vaccine cohort (April 2021 - May 2021) after vaccine availability. Descriptive statistics were used to summarize preliminary findings. Results: Participants included 273 AYAs with cancer (mean age, 33.8 years old, 26% male, 73% non-Hispanic White, 11% in active treatment, 53% in post-vaccine cohort). Of 71.7% who participated in at least one telehealth visit, 50.9% were somewhat or very satisfied with their visit(s). Topics that all participants preferred to address via telehealth included: stress management (34%); sleep quality (31.7%); diet/nutrition (32.1%); and mental health (29.5%).Topics least preferred for telehealth included fertility counseling (16.7%) and sexual health (13.7%). Open-ended comments from participants highlighted the importance of healthcare providers taking time to listen to their concerns during their visits. Participants suggested that telehealth encounters can be improved by ensuring adequate time for the visit plus good video and audio quality, and using telehealth for follow-up visits rather than initial consultations. Conclusions: About half of AYAs who had participated in a telehealth visit indicated satisfaction with the visit(s). Findings indicated AYAs’ preferences for the types of topics that are most and least preferred to address in telehealth visits, as well as specific recommendations for improving the quality of visits. Consideration of AYAs’ preferences and recommendations in the ongoing implementation of telehealth may help improve patient satisfaction.