Background: In 2016, the Canadian Partnership Against Cancer distributed surveys to over 40,000 cancer survivors to understand their experiences transitioning from primary cancer treatment to follow-up cancer care. Previously reported results of this survey identified that cancer survivors had high rates of unmet physical, emotional and practical needs. This study describes the association between these unmet needs and emergency services (ES) utilization within the first three years after cancer treatment. Methods: 13,319 respondents returned the survey (response rate 33%). Respondents in this study have non-metastatic breast, hematologic, colorectal, melanoma or prostate cancer. The association between self-reported unmet needs and ES utilization was assessed using multivariable logistic regression. High ES utilization was defined as accessing ES more than three times per year during the first three years after active cancer treatment. Results: 8,911 participants are included in this analysis; 80.5% reported at least one unmet practical, physical, and emotional need (n=7169, Table). A total of 3.9% (n=344) reported high ES utilization. Unmet needs were a significant predictor of high ES utilization (OR 1.75 95% CI 1.14-2.68 p=0.01). Other significant predictors of high ES utilization on the multivariable analysis included: not being able to identify a healthcare provider in charge of follow-up cancer care (OR 2.73 95% CI 1.32-5.65 p=0.01), high oncologist utilization (OR 3.08 95% CI 2.28-4.15 p<0.01), high primary care provider utilization (OR 2.3 95% CI 1.76-3.0 p<0.01), having a chronic condition (OR 1.6 95% CI 1.19-2.07 p<0.01), having colorectal cancer (OR 2.12 95% CI 1.31-3.44 p<0.01), being enrolled in a clinical trial (OR 1.54 95% CI 1.11-2.16 p=0.01), and rating follow-up cancer care coordination as fair or poor (OR 1.39 95% CI 1.03-1.86 p=0.03). Conclusions: Unmet needs are associated with high ES utilization in the first three years after cancer treatment. A better understanding of the reasons for this association is required to develop approaches to reduce potentially preventable ES utilization and improve perceived care needs among cancer survivors.