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Introduction Malnutrition is a serious problem that causes high morbidity and mortality among cancer patients. There was no sufficient empirical evidence on the prevalence of malnutrition and associated factors among adult cancer hospitalized patients in Ethiopia. Objective This study aimed to assess the prevalence and risk factors of malnutrition among adult cancer patients receiving chemotherapy in cancer center, Ethiopia 2019. Methods A cross-sectional study was conducted among a sample of 281 patients selected using systematic sampling among cancer patients receiving chemotherapy. Data were collected by patient interviews and chart reviews using a structured questioner adapted from a subjective global assessment tool. Data were analyzed by SPSS version 24.0. Descriptive statistics such as frequency distribution, mean, median, and standard deviation were used to describe characteristics. Bivariate and multivariable analyses using logistic regression models were used. Result Of the 281 participating patients, 58.2% had malnutrition, which was higher among females (51.6%) than males (48.4%). The mean body mass index was 20.24 ± 3.6. Of all, 41.9% had moderate weight loss, 21.1% had severe weight loss and 52.3% had weight loss in the past two weeks. Stage four cancer (AOR = 7.2, 95% CI: 1.3–38.5), loss of appetite (AOR = 4.5, 95% CI; 1.5–17.2) and diarrhea (AOR = 7.8, 95% CI: 2.95–20.5) were significantly associated with malnutrition. Conclusion The prevalence of malnutrition among cancer patients who receive chemotherapy was high. Stage of cancer, appetite loss, and presence of diarrhea was found to be significant factors for malnutrition., Cancer; Malnutrition; Prevalence; Risk factors; Tikur Anbessa Specialized Hospital; Ethiopia.