Abstract: Objective This study aims to evaluate the insomnia and fatigue symptoms of cancer patients and analyzes their influencing factors. Methods A total of 604 cancer patients were investigated using a basic data collection form, the Generalized Anxiety Disorder Scale, Patient Health Questionnaire, and Fear of Cancer Recurrence Scale. Univariate analyses, multiple logistic regression analyses, structural equation modeling analyses were conducted. Results A total of 604 completed questionnaires were collected in this study, and 210 patients （34.8%） reported sleep disturbances; while 318 patients （52.6%） reported fatigue symptoms. Multivariate logistic regression analyses showed that: older patients odds ratio（OR）=5.491, 95% confidence interval（CI）=1.939~15.560, P=0.001）, anxiety （OR=3.810, 95%CI=1.692~8.581, P=0.001）, depressive symptoms （OR=7.828, 95%CI=2.555~23.987, P<0.001）, and severe fear of cancer recurrence （OR=6.787, 95%CI=2.426~18.986, P<0.001） were significantly associated with insomnia symptoms, while anxiety （OR=1.769, 95%CI=1.020~3.068, P=0.042） and depressive symptoms （OR=5.370, 95%CI=2.811~10.262, P<0.001） were significantly associated with fatigue symptoms. Structure equation modeling analyses showed that depression （β=1.13, P<0.001） and fear of cancer recurrence （β=0.94, P<0.05） directly affected the individual's insomnia symptoms. Additionally, depression （β=1.18, P<0.001） directly affected the symptoms of fatigue. Conclusion Anxiety, depression, and fear of cancer recurrence significantly affected the symptoms of insomnia and fatigue in cancer patients. Clinical interventions based on those key components could be helpful to improve the mental and physical health of cancer patients.