Purpose <p>The aim of this study was to quantify the interrelationship between fatigue and sleep disturbance among lung cancer survivors attending traditional Chinese medicine (TCM) rehabilitation clinics.</p> Methods <p>Symptom burden was assessed through MD Anderson Symptom Inventory-TCM across four time points within two months following the initial visit. A Mixed-effect model was applied to analyze the factors influencing fatigue. The group-based dual trajectory model (GBDTM) was employed to identify the symptom trajectories of fatigue and sleep disturbance and further quantify their interrelationship. Logistic regression models were used to determine the factors associated with different trajectories.</p> Results <p>239 lung cancer survivors were included in this study with sleep disturbance and fatigue reported as the most severe symptoms. The severity of sleep disturbance was positively correlated with that of fatigue. Three distinct trajectories for fatigue have been identified: Low (27%), moderate (55%), and high (18%). Patients with low level sleep disturbance were most likely to be members in the low-to-moderate fatigue group (96.5%), while patients with high level sleep disturbance were most likely to be members in the moderate-to-high fatigue group (93.7%). Notably, patients experiencing high level sleep disturbance had a nearly tenfold increase in the probability of experiencing high level fatigue. Patients with higher BMI (≥ 24) were less likely to be in the high fatigue group, while those with higher ECOG-PS (≥ 1) were more likely to belong to this group.</p> Conclusion <p>High level sleep disturbance exacerbated fatigue among lung cancer survivors. BMI and ECOG-PS score had predictive value in fatigue severity.</p>