Objective To analyze the changes of the allocation and utilization of anti-tumor essential medicines in public medical institutions in Shandong province before and after the issuance of the National Essential Medicines List (2018 Edition), and investigate the pharmaceutical service capabilities.Methods The questionnaire survey and the data extracted from the platform of Shandong Provincial Health Commission were applied to analyze the purchase amount of anti-tumor essential medicines, their allocation and utilization in medical institutions, daily treatment costs, pharmaceutical care ability in all secondary and above public medical institutions in Shandong province in 2018 and 2019.Results Among the 17 cities in Shandong province, the city Jinan had the largest purchase amount of anti-tumor essential medicines, and Weifang city made the biggest increase in the purchase amount of anti-tumor essential medicines. Overall, the allocation rate of anti-tumor essential medicines in secondary medical institutions was lower than that of the tertiary medical institutions. The purchase amount of targeted drugs, adjuvant drugs, hormone drugs and alkylating agents took an increasing trend, while that of the anti-metabolites, antibiotics, plant component drugs, and other classes of anti-tumor drugs decreased. Five novel anti-tumor drugs which entered the National Essential Medicine List (2018 Edition) for the first time had their consumption sum increased significantly in 2019. Among the EGFR-TKIs, gefitinib had the largest consumption and the lowest daily treatment cost. In addition, the pharmacists took a low degree of involvement in the follow-up of cancer patient. The collection and reporting of adverse drug reactions were the main means of safety monitoring and evaluation of anti-tumor essential medicines.Conclusion There was a large gap of allocation and utilization of anti-tumor essential medicines between different cities, different medical institutions, or different types of anti-tumor medicines. The National Essential Medicines List (2018 Edition) promoted the allocation and use of anti-tumor essential medicines in medical institutions in Shandong province. The medicines newly included in the list, especially novel anti-tumor medicines, had a great increase in the allocation and utilization in medical institutions. Besides, the anti-tumor pharmaceutical care ability of medical institutions needs to be improved.