Cervical cancer remains one of the leading causes of cancer-related deaths among women in Ethiopia. However, limited evidence exists regarding the survival outcomes and associated factors among cervical cancer patients, particularly in conflict-affected regions like Tigray. This study aimed to assess the survival time and its predictors among cervical cancer patients treated at Ayder Comprehensive Specialized Hospital and Axum specialized referral hospitals between 2018 and 2023.

A retrospective follow-up study was conducted on 91 cervical cancer patients. Data were extracted from medical records using a structured checklist. The primary outcome was time to death from cervical cancer, measured in months. Survival probabilities were estimated using the Kaplan-Meier method, and the log-rank test was used to compare survival across categories. Life tables were used to summarize the probability of survival at specified time intervals. Cox proportional hazards model was employed to identify predictors of mortality, with hazard ratios and 95% confidence intervals reported. The Cox-Snell residual plot was used to assess model adequacy.

The overall median survival time was 19.5 months, with a Four-year cumulative survival rate of just 3.7%. The incidence rate was high at 40.5 per 1,000 person-months, based on a total follow-up time of 1,431 person-months. Survival outcomes were significantly worse than in comparable Ethiopian studies. Older age and those who underwent chemo and radiotherapy were significantly associated with increased hazard of death. Surprisingly, patients who reported that healthcare providers did not exhibit supportive and respectful behavior had a 62% lower hazard of death (HR = 0.38; 95% CI: 0.18–0.81), a counterintuitive finding that may reflect reverse causality or reporting bias.

Cervical cancer survival in this cohort was markedly low compared to national and international findings. Older age and chemotherapy were associated with higher mortality. The unexpected association between perceived provider behavior and survival warrants further qualitative investigation. To improve outcomes, targeted efforts should focus on strengthening early detection and treatment services, particularly for older women.