Background:There is a significant global disparity on the provision of palliative care services for individuals with life-limiting illnesses and palliative care remains an urgent, neglected need in developing countries. In Ethiopia, there is a paucity of information on the patient’s perception about palliative care and the factors influencing the likelihood of service utilization among adult cancer patients. Objectives: To assess the perception about palliative care and factors influencing the likelihood of service utilization among adult cancer patients in Tikur Anbessa Specialized Hospital, Ethiopia from January 1to March 31, 2019. Methods: A facility-based cross-sectional study conducted among 304 systematically selectedadult cancer patients in the cancer unit of Tikur Anbessa Specialized Hospital. A pretested structured interviewer-administered questionnaire was used for data collection. Multivariable binary logistic regression model was carried out to control for the potential confounders and to identify the independent factors associated with palliative care service utilization. P-value <0.05 was used to declare statistical significance and goodness of fit of the model assessed using Hosmer and Lemeshow goodness of fit test. Results:A little more than half of the patients had aperception on the availability of palliative care service174(57.2%), adult cancer patients who earn≥ 1,500-birrs monthly income were 2.36 times more likely to utilize palliative care service as compared to their counterparts who earn a monthly income of <1,500 birrs (AOR=2.36, 95% CI 1.37,4.06), after controlling the effect of other covariates. Similarly, having family members of more than two was associated with higher utilization (AOR=2.28, 95% CI 1.02,5.13) Conclusion and recommendations: Significant number of adult cancer patients were nothaving perception about utilizing palliative care service and higher monthly income and having more than two family memberswere the factors strongly associated with higher likelihood of palliativecare service utilization. Multiple stakeholders should be involved in reducing the financial constraints that hinder patients not to utilize palliative care service and to improve social support for those who have few or no family members.