Study Objective: Adult cancer patients with COVID-19 were shown to be at higher risk of ICU admission. Previously published prediction models showed controversy and enforced the importance of heterogeneity among different populations studied. The aim of this study was to detect the predictors of ICU admission for adult COVID-19 patients with cancer who present to the emergency department (ED).Methods: Theis a retrospective cohort study. It was conducted on adult cancer patients older than 18 years who presented to the EDof the American University of Beirut MedicalCenter from February 21, 2020, till February 21, 2021, and were found to have COVID-19 infection. Relevant electronic data were extracted. The association between different variables and ICU admission was tested. Logistic regression was done to adjust for confounding variables. P value less than 0.05 was considered significant.Results: Eighty-nine distinct patients were included. About 37% were admitted to the ICU (n=33). Higher ICU admission was seen in patients who had received chemotherapy within one month, had a respiratory rate at triage > 22 breaths per minute, an oxygen saturation < 95%, and/or a higher CRP upon presentation to the ED. After adjusting for confounding variables only recent chemotherapy and higher respiratory rate at triage were significantly associated with ICU admission. Conclusion: Physicians need to be vigilant when taking care of covid infected oncology patients. Patients who are tachypneic at presentation and those who have had chemotherapy within one month are at high risk for ICU admission.