Objective To investigate and analyze the incidence and risk factors of chemotherapy induced fatigue in elderly lung cancer patients. Method 120 elderly lung cancer patients admitted to our hospital from March 2020 to March 2023 were selected as the survey subjects. All patients received unified chemotherapy treatment and were evaluated using the Piper fatigue scale. The number of patients with cancer induced fatigue was counted and the incidence of fatigue was calculated. According to the occurrence of fatigue in patients they were divided into a fatigue group and a normal group and the risk factors of cancer induced fatigue in elderly lung cancer patients undergoing chemotherapy were analyzed using univariate and multivariate logistic regression. Result Out of 120 elderly lung cancer patients 79 patients experienced cancer induced fatigue fatigue with an incidence rate of 65. 83%. The patients were divided into a fatigue group 79 cases and a normal group 41 cases . Univariate analysis showed that the age tumor stage basic disease history and incidence of complications of the fatigue group were higher than those of the normal group while serum albumin ALB was lower than that of the normal group P < 0. 05 . Multivariate analysis shows that advanced age high tumor staging comorbidities with underlying diseases complications and low ALB are independent risk factors for cancer related fatigue in elderly patients with lung cancer undergoing chemotherapy. Conclusion Elderly lung cancer patients generally experience cancer induced fatigue symptoms during chemotherapy among which advanced age high tumor staging comorbidities with underlying diseases complications and low ALB are independent risk factors for the occurrence of cancer induced fatigue.