Objective To analyze the status quo and influencing factors of chemotherapy-induced nausea and vomiting (CINV) and its relationship with cancer-related fatigue (CRF) in elderly patients with gynecological malignant tumors. Methods A total of 206 elderly women who suffered from gynecologic cancer and had received chemotherapy in the Breast Department of Yuncheng Central Hospital from March 2021 to September 2022 were recruited as the research subjects. According to the occurrence of CINV, they were divided into a CINV group (92 cases) and a non-CINV group (114 cases). Their clinical data were collected. Multidimensional fatigue Inventory (MFI-20) was used to evaluate their CRF status, and the results were analyzed for its relationship with CINV. SPSS statistics 22.0 was employed for data analysis. Independent sample t test, Chi-square test or rank sum test was applied for intergroup comparison depending on different data type. Logistic regression model was conducted to analyze the risk factors affecting CINV in elderly patients with gynecologic cancer. Results Among the 206 patients, 92 cases (44.66%) developed CINV, including 52 cases (56.52%) of acute CINV and 40 cases (43.48%) of delayed CINV, and 34 cases (36.96%) of mild, 35 cases (38.04%) of moderate and 23 cases (25.00%) of severe CINV. Multivariate logistic regression analysis showed that history of stomach diseases (OR=2.438,95%CI 1.106-5.372), history of motion sickness (OR=3.051,95%CI 1.460-6.376), chemotherapy regimen containing cisplatin(OR=3.678,95%CI 1.519-8.911), anxiety (OR=2.542,95%CI 1.174-5.508), depression (OR=2.333,95%CI 1.098-4.959) and CRF (OR=2.769,95%CI 1.232-6.221) were independent risk factors for CINV (all P<0.05). There were statistical differences in CRF level and MFI-20 score among the patients with different severities of CINV (P<0.05). Conclusion For elderly patients with gynecologic cancer, history of stomach diseases, history of motion sickness, chemotherapy regimen containing cisplatin, anxiety, depression and CRF are independent risk factors for CINV, and CRF level is closely associated with the severity of CINV.