Objective To explore the factors that would affect cancer related fatigue (CRF) in patients with gynecological malignant tumors receiving chemotherapy, and to analyze the pathway of psychosocial factors to CRF. Methods A total of 185 inpatients with gynecologic tumor were recruited by convenience sampling. The General data questionnaire, Chinese version of the Connor-Davidson Resilience Scale (CD-RISC), the Social Support Rating Scale and Multidimensional Fatigue Inventory-20 (MFI-20) were used for survey. The data were analyzed using SPSS22.0 software and the PROCESS3.3 plug-in. Results The patients scored (35.44±14.40) points in CRF, with respectively 57.84% and 11.35% having moderate and severe fatigue. The results of multiple linear regression analysis showed that psychological resilience, daily walking steps, pain, support utilization and commercial insurance were independent influencing factors of CRF in the patients. The mediation test showed that the mediation effect of support utilization was -0.055, and the proportion of mediation effect to the total effect was 15.03%. Conclusion The incidence of CRF was high in patients with gynecological malignant tumors receiving chemotherapy. Medical staff should formulate intervention plans targeting the modifiable factors (e.g., pain, exercise) to help relieve fatigue. In addition, given that support utilization works as a mediator of between psychological resilience and CRF, improving patient support utilization could be a breakthrough in the prevention and treatment of CRF.