Post mastectomy pain syndrome at an Indian tertiary cancer centre and its impact on quality of life

Background: Literature on Post mastectomy pain in the Indian population is scarce. Most literature is from the West. The current study aimed to identify the incidence of post?mastectomy pain syndrome (PMPS), pain severity, and its impact on quality of life in Indian patients. Method: Prospective observational study of 120 women undergoing mastectomy between March and December 2017, followed until 6 months after surgery. The Brief Pain Inventory (BPI) questionnaire and the quality of life questionnaire (QLQ) by the European Organization for Research and Treatment of Cancer (EORTC) and known as (EORTC?QLQ 30) were used to identify the impact on function and quality of life. Results: A 35.8% PMPS incidence was identified at 6 months after mastectomy. Pain was located in the anterior chest wall (41.8%), axilla (32.6%), and medial upper arm (25.6%). Most (48.8%) patients described it as dull aching and of mild intensity (55.8%). No significant association of age, BMI, surgery, Intercostobrachial nerve (ICBN) dissection, postoperative pain severity, pain history {dysmenorrhea, headache}, and postoperative radiotherapy with PMPS was found. Pain interfered with daily activities and quality of life in those with PMPS, as deduced from BPI and EORTC?QLQ. Conclusion: PMPS is very much a problem affecting the quality of life in our set of patients. Most women tried to cope and accept the pain as part of the treatment process. This shows the need for creating awareness about PMPS among healthcare providers and patients alike. Early identification and treatment of post mastectomy pain should be an essential aspect of patient care

Research progress on use of tissue equivalent filler in postmastectomy radiation therapy of breast cancer / 中华放射肿瘤学杂志

Although the use of postmastectomy radiation therapy (PMRT) has been proven to bring survival benefit to breast cancer patients, the use of chest wall tissue equivalent filler (bolus) remains controversial. In recent years, a large number of studies have shown that the use of bolus in PMRT does not significantly improve the local control rate, while it can significantly increase the acute skin toxicity, and even leads to more frequent and longer treatment interruption. Existing retrospective studies have indicated that for breast cancer patients undergoing mastectomy and systemic therapy, if there is no skin invasion, it is recommended not to routinely use bolus during radiotherapy. However, higher-level clinical studies are needed for further confirmation.

Physical, emotional, and social well-being and toxicity assessment in post-mastectomy female breast carcinoma patients undergoing adjuvant treatment

Objective: Breast carcinoma is one of the most common cancers in India. Breast cancer is usually associated with serious side effects due to the long-term treatment procedure. This study investigates how to improve the overall quality of life (QoL) of patients in physical, psychological, and social aspects. Materials and Methods: Records of patients attending the Radiotherapy Outpatient Department (OPD) from May 2019 to June 2021 were analyzed retrospectively. Records of several patients available in the department were reviewed by the census method, which is based on pre-decided inclusion and exclusion criteria. Results: Out of 105 patients included in the study, 38.1% (N=40) of the patients were graduates, and 30.5% (N=32) of the patients were illiterate; 54.3% (N=57) of the patients belong to rural areas. Only 24.8% (N=26) of the patients were employed and the remaining 75.2% (N=79) of the patients were unemployed. However, most of the patients (41.0%) developed grade 1 acute skin toxicity, among which a maximum number of patients (N=47) developed grade1 late skin toxicity. After radiotherapy among all included patients, almost 13.0% of the patients developed arm edema. According to the Hospital Anxiety and Depression Scale score, the maximum abnormal scores for depression were 60.0% (N=63) and for anxiety 59.0% (N= 62). Conclusion: This study emphasizes that older women and those from lower socio-economic strata tolerated chemotherapy and radiotherapy better. We can also conclude that improved QoL has been a major concern for breast cancer patients undergoing long-term treatment. In a post-treatment setting, serial evaluation of the QoL not only improves the treatment outcome but can also be a prognostic factor.

Dosimetric comparison between conventional IMRT and EBCRT combined with IMRT for post-mastectomy left-sided breast cancer patients / 中华放射医学与防护杂志

Objective:To investigate the dosimetric differences between conventional IMRT and electron beam conformal radiotherapy (EBCRT) combined with IMRT for post-mastectomy left-sided breast cancer patients.Methods:A total of 20 post-mastectomy left-sided breast cancer patients who were treated in the Ningbo First Hospital from June 2018 to October 2021 were retrospectively studied. The planning target volume (PTV) included the supra-and infra-clavicular regions(PTV sc)and the ipsilateral chest wall (PTV cw), and the prescribed dose was 50 Gy/25 f. All radiotherapy plans were designed using the Varian Eclipse treatment planning system (TPS). After that, the dose distribution of the target volume and the dose exposure of organs at risk (OARs) were compared and analyzed. Results:All the IMRT plans met the clinical requirements, yet 2/20 of the EBCRT combined with IMRT plans were not clinically accepted. For these two patients, the maximum chest wall thickness was 3.7 cm and 4.4 cm each, and the designed electron beam energy was 12 MeV and 15 MeV, respectively. The dose to the ipsilateral lung of these two patients exceeded the institution-specific dose limit standard. For the remaining 18 patients whose chest wall thickness was 3 cm or less, the designed electron beams were 9 MeV or less. All the EBCRT combined with IMRT plans were clinically accepted. The target dose distribution of the conventional IMRT was better than that of the EBCRT combined with IMRT (uniformity index (HI): PTV sc: t = -10.20, P<0.05; PTV cw: t = -9.24, P<0.05; conformal index (CI): PTV all: t = 10.39, P <0.05). For OARs, the V5 Gy, V20 Gy, and Dmean of the ipsilateral lung of EBCRT combined with IMRT were lower than those of IMRT ( t = 5.98, 6.30, 11.30, P <0.05). Specifically, the V25 Gy and Dmean of heart decreased by 8.3% and 4.79 Gy, respectively ( t = 15.23, 15.76, P<0.05), the Dmean of the left anterior descending coronary artery (LADCA) decreased by 44.03% ( t = 11.69, P <0.05), and the V5 Gy and Dmean of the contralateral breast decreased by 7.9% and 0.8 Gy, respectively ( t = 3.66, 4.93, P<0.05). The dosimetric differences of other OARs were not statistically significant ( P > 0.05). Conclusions:For post-mastectomy left-sided breast cancer patients with a chest wall thickness of less than 3 cm, EBCRT combined IMRT can significantly reduce the exposure dose to the heart, the ipsilateral lung, and the contralateral breast, which is beneficial to reducing the potential risk of long-term complications after radiotherapy and can further improve the long-term overall survival rate of patients. For patients with thick chest wall, IMRT plans are more technologically ideal.

A study on Development and Implementation of the Psychophysiological Well-being Assessment Tool based on Roy’s Adaptation Model for breast cancer patients

Breast cancer is a major health burden among Indian females in their young age. As the females came to know the disease isalready in advance stage. To get rid from the complications they have to undergo for mastectomy and after mastectomy they havedisturbed Psychophysiological Wellbeing. In the present methodological study researcher has developed PsychophysiologicalWellbeing Assessment Tool (PWAT) based on Roy's Adaptation Model after three rounds of item analysis and Delphi surveywith experts of different fields of nursing to assess their Psychophysiological wellbeing. After the finalization of PWAT it wasimplemented on 200 post mastectomy breast cancer patients who were under radiation therapy or chemotherapy and selected byNon- probability purposive sampling technique, in Rajinra Hospital Patiala. Data was collected and analyzed by using descriptiveand inferential statistics. Common consensus of experts was obtained from 72 pooled items to final version of PWAT with 38items. The reliability of instrument was estimated by using split half Chronbachs alpha which was r=0.87. Statistically all theitems of PWAT were found inter correlated and were compatible to each other. The mean score range of physiological well-beingwas 57.40 as compared to mean score range of the psychological well-being of breast cancer patients was 83.17.There waspositive correlation (0.347) between physiological wellbeing and psychological wellbeing at the level of 0.001. Thus it wasstatistically evident that if physiological well-being score increased then psychological wellbeing score also increased. Thus itmay be concluded that if the nurses would be equipped with PWAT, they will do quick assessment of psychophysiologicalwellbeing of post mastectomy breast cancer patients. Their timely intervention will help in decreasing re-hospitalizations ofpatients and help in cost containment for the health care industry which is the essence of quality care management.

Conventional Radiotherapy with Hypofractionated Radiotherapy in Post-Mastectomy Breast Cancer Patients: A Prospective Comparative Study

Aim: The aim of this study is to assess the efficacy, toxicity, and feasibility of hypofractionated radiotherapy in post-mastectomybreast cancer patients compared with conventional radiotherapy.Materials and Methods: A total of 80 post-mastectomy breast cancer patients were randomized into two groups for adjuvantradiotherapy. Control group of 40 patients received conventional radiotherapy of 50 GY in 5 weeks. Study group of 40 patientsreceived hypofractionated radiotherapy of 42.72 GY in 3.1 weeks.Results: The statistical analysis of the study was performed in terms of tolerability, radiation toxicities, and feasibility of thehypofractionated radiotherapy over conventional radiotherapy. There was found to be no significant difference between thetwo groups.Conclusion: In breast cancer patients after post-mastectomy, hypofractionated radiotherapy in comparison to conventionalradiotherapy finds comparable outcomes without any significant difference in radiation-induced toxicities.

Dosimetric comparison of target-segmented plan versus conventional IMRT plan for post-mastectomy left-sided breast cancer patients / 中华放射医学与防护杂志

Objective@#To compare the dosimetric differences among Target-Segmented Plan (TSP), Non-TSP, and conventional static 8-field intensity modulated radiation therapy (8F-IMRT) plan for post-mastectomy irradiation of left-sided breast cancer patients.@*Methods@#This study enrolled thirty consecutive breast cancer patients who underwent radical mastectomy and treated with post-op radiation in Department of Radiation Oncology, Renmin Hospital of Wuhan University from June 2017 to November 2018.The clinical target volume (CTV) included the ipsilateral chest wall, supra/infra-clavicular, high-risk partial axillary in high risk, and internal mammary nodes (IMN). The organs at risk (OARs) near the targets, including ipsilateral lung, heart, contralateral breast, ipsilateral humeral head and spinal cord, were contoured as well. The maximum distance of PTV′s tangent to the outermost side of the affected lung was more than 2 cm. Depending on the maximum distance, the patients were classified into three groups: A(<3 cm), B(3~4 cm) and C(>4 cm), respectively. Three types of treatment plans (TSP, Non-TSP and 8F-IMRT) were created for each patient using the Eclipse treatment planning system with the same dose optimization objective . The dose-volume histograms were compared for the PTVs and OARs.@*Results@#All plans achieved the intended dose criteria.The D98% of TSP was lower than that of Non-TSP and 8F-IMRT (Z=-3.294, -3.266, P<0.05). However, the homogeneity index (HI) and conformal index (CI) of the three plans had no statistically significant difference among the three plans (P>0.05). Non-TSP required more Monitor Units (MUs)than the other two plans (Z=-3.04, -2.669, P<0.05). The Dmean of TSP was higher than that of 8F-IMRT (Z=-3.181, P<0.05). Compared with Non-TSP and 8F-IMRT plans, TSP significantly reduced V5 Gy, V10 Gy, V20 Gy and Dmeanof ipsilateral lung and heart in all patients (lung: V5 Gy: Z=-3.408, -3.408; V10 Gy: Z=-3.408, -3.408; V20 Gy: Z=-3.408, -3.124; Dmean: Z=-3.408, -3.408, P<0.05; heart: V5 Gy: Z=-3.408, -3.408; V10 Gy: Z=-3.408, -3.408; V20 Gy: Z=-2.499, -3.067; Dmean: Z=-3.408, -3.408, P<0.05). The Dmean of contralateral breast in Non-TSP was higher than that in TSP and 8F-IMRT (Z=-2.954, -2.215, P<0.05), and the Dmaxhas no significant difference in (P>0.05). There was no significant difference in spinal cord Dmax among the three plans, but the Dmean of humeral head in 8F-IMRT was higher than that in TSP and Non-TSP (Z=-3.01, -2.442, P<0.05). In the three groups, the mean amplitude of difference comparing Non-TSP and 8F-IMRT with TSP in ipsilateral lung(V5 Gy, V10 Gy, V20 Gy) and heart(V5 Gy, V10 Gy, Dmean) satisfied the relation: D(N-T, A)<D(N-T, B) <D(N-T, C)和D(8F-T, A)<D(8F-T, B) <D(8F-T, C).@*Conclusions@#For post-mastectomy left-sided breast cancer patients, TSP is not only dosimetrically feasible as Non-TSP and 8F-IMRT treatment techniques, but also could effectively reduce the irradiation volume of the ipsilateral lung and heart in the low dose area with minimum adverse dosimetric impact on the treatment targets and other OARs.The advantage of TSP is more prominent with increasing curvature of the clinic target volume.

Effect of ultrasound-guided intercostobrachial nerve blockade in patients with post-mastectomy pain syndrome / 临床麻醉学杂志

Objective To investigate and evaluate the feasibility and analgesic effect of ultrasound guided intercostobrachial nerve (ICBN) blockade in patients with persistent pain after radical mastectomy with ICBN preservation.Methods In a total of 53 following-up female cases,aged 18-55 years,ASA Ⅰ or Ⅱ,receiving radical mastectomy with ICBN preservation during January,2014 to February,2016,19 patients complained persistent pain in the lateral chest,axilla and/or upper arm more than 3 months after the surgery were enrolled.ICBN blockade was performed using 0.5% ropivacine 10 mL injected in the potential space between the superior of pectoralis minor muscle and the inferior of serratus anterior muscle in the second intercostal space guided by ultrasound.Visual analogue scale (VAS) was applied to assess the pain intensity at rest,on movement,and with 100 kPa pressure before blockage and 30 min thereafter,and then the pain intensity (SPI) was calculated.All nerve blockade-related adverse events including local anesthetic-related allergy,central nervous system and cardiovascular toxicity were recorded.Seven-day follow-ups were required in all patients to assess the pain intensity.Results All 19 cases completed ICBN blockade guided by ultrasound,of which 17 cases completed the seven-day follow-ups.The mean difference in SPI was-9.19 VAS points (95%CI-11.24--7.14,P<0.01).Compared with each mean VAS and SPI before block,all that after block at day 1-6 were significantly decreased (P<0.01 or P<0.05).There were 14(82.4%),13(76.5%),7(41.2%) and 3(17.6%)cases that SPI was decreased over 5 points after block at day 1-4.No nerve blockade-related adverse event was observed.Conclusion Ultrasound guided ICBN blockade can relieve persistent post-mastectomy pain safely and effectively.

Incorporating Risk Factors to Identify the Indication of Post-mastectomy Radiotherapy in N1 Breast Cancer Treated with Optimal Systemic Therapy: A Multicenter Analysis in Korea (KROG 14-23) / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: In a recent meta-analysis, post-mastectomy radiotherapy (PMRT) reduced any first recurrence (AFR) and improved survival in N1 and N2 patients. We investigated risk factors for AFR in N1 after optimal systemic therapy without PMRT, to define a subgroup of patients who may benefit from PMRT. MATERIALS AND METHODS: One thousand three hundred eighty-two pT1-2N1M0 breast cancer patients treated with mastectomy without PMRT between 2005 and 2010 were retrospectively analyzed. Only 0.6% had no systemic therapy. RESULTS: After a median follow-up of 5.9 years, there were 173 AFR (53 loco-regional recurrence [LRR] without distant metastases [DM], 38 LRR with DM, and 82 DM without LRR). The 5-year LRR and AFR rates were 6.1% and 12.0%, respectively. Multivariate analysis revealed that close resection margin (p=0.001) was the only independent risk factor for LRR. Multivariate analysis for AFR revealed that age < 35 years (p=0.025), T2 stage (p=0.004), high tumor grade (p=0.032), close resection margin (p=0.035), and triple-negative biological subtype (p=0.031) were independent risk factors. Two or three positive lymph nodes (p=0.078) were considered a marginally significant factor. When stratified by these six factors, the 5-year LRR rates were 3.6% with 0-1 (n=606), 7.5% with 2-3 (n=655), and 12.7% with 4-6 (n=93) risk factors. The 5-year AFR rates were 7.1% with 0-1, 15.0% with 2-3, and 24.5% with 4-6 risk factors. CONCLUSION: Patients with pT1-2N1M0 breast cancer who underwent mastectomy and optimal systemic therapy showed excellent loco-regional control and disease control. The patients with four or more risk factors may benefit from PMRT, and those with two or three risk factors merit consideration of PMRT.

Incorporating Risk Factors to Identify the Indication of Post-mastectomy Radiotherapy in N1 Breast Cancer Treated with Optimal Systemic Therapy: A Multicenter Analysis in Korea (KROG 14-23) / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: In a recent meta-analysis, post-mastectomy radiotherapy (PMRT) reduced any first recurrence (AFR) and improved survival in N1 and N2 patients. We investigated risk factors for AFR in N1 after optimal systemic therapy without PMRT, to define a subgroup of patients who may benefit from PMRT. MATERIALS AND METHODS: One thousand three hundred eighty-two pT1-2N1M0 breast cancer patients treated with mastectomy without PMRT between 2005 and 2010 were retrospectively analyzed. Only 0.6% had no systemic therapy. RESULTS: After a median follow-up of 5.9 years, there were 173 AFR (53 loco-regional recurrence [LRR] without distant metastases [DM], 38 LRR with DM, and 82 DM without LRR). The 5-year LRR and AFR rates were 6.1% and 12.0%, respectively. Multivariate analysis revealed that close resection margin (p=0.001) was the only independent risk factor for LRR. Multivariate analysis for AFR revealed that age < 35 years (p=0.025), T2 stage (p=0.004), high tumor grade (p=0.032), close resection margin (p=0.035), and triple-negative biological subtype (p=0.031) were independent risk factors. Two or three positive lymph nodes (p=0.078) were considered a marginally significant factor. When stratified by these six factors, the 5-year LRR rates were 3.6% with 0-1 (n=606), 7.5% with 2-3 (n=655), and 12.7% with 4-6 (n=93) risk factors. The 5-year AFR rates were 7.1% with 0-1, 15.0% with 2-3, and 24.5% with 4-6 risk factors. CONCLUSION: Patients with pT1-2N1M0 breast cancer who underwent mastectomy and optimal systemic therapy showed excellent loco-regional control and disease control. The patients with four or more risk factors may benefit from PMRT, and those with two or three risk factors merit consideration of PMRT.

The follow-up of post-mastectomy patients: Should the ipsilateral side be assessed with both mammogram and ultrasound?

Aim: This study aimed to determine findings of axillary view mammogram (MMG) and ultrasound (USG) of the ipsilateral side in post-mastectomy patients and to document difficulty level in performing the axillary view and patients’ pain level during the procedure. Methods: Post-mastectomy patients who had MMG and USG on follow-up during an 18-months period were included. The MMG and USG findings of 183 patients were reviewed and histology results were recorded when available. Radiographers’ difficulty and patients’ pain level during the axillary view MMG were charted. Results: On MMG, 172 cases were normal, eight cases were benign (Category 2) and three cases indeterminate (Category 3). On USG, 175 cases were normal, three cases were benign (Category 2) and five cases indeterminate (Category 3). Malignant lesions detected in two out of 183 patients (1%) were metastatic carcinoma in bilateral axillary lymph nodes and leiomyosarcoma at the mastectomy site. These two cases were Category 3 on USG with negative MMG findings. In majority of cases (79%), the radiographer had no difficulty performing the axillary view compared with contralateral MMG. Majority of patients (80%) experienced similar pain during axillary view compared to contralateral MMG. Conclusion: Follow-up imaging of post-mastectomy patients should include (i) USG of the mastectomy site, both axillary regions, and the contralateral breast, and (ii) MMG of the contralateral side. Ipsilateral axillary view MMG is not necessary.

Effects of emotional care intervention on the quality of life of breast cancer patients undergoing radical operation / 现代临床护理

Objective To investigate the effects of emotional care on the quality of life of breast cancer patients undergoing radical operation.Methods Emotional nursing intervention was conduced to 70 breast cancer patients undergoing radical operation. The modified life quality scale was used before and after the radical operations for the investigation of their quality of life.Result The score on the quality of life after emotional care was significantly higher than that after the emotional care(t=-2.07,P<0.05).Conclusion Emotional care may raise breast cancer patients’quality of life after the radical mastectomy.

Recursos fisioterapêuticos em linfedema pós-mastectomia: uma revisão de literatura / Physical therapy resource in post-mastectomy lymphedem a review of the literature

O linfedema pós-mastectomia é um quadro patológico crônico e progressivo, que gera déficit no equilíbrio das trocas de líquidos intersticiais, resultante principalmente da dissecção axilar do nódulo, da radioterapia na axila e da quimioterapia. Objetivo: Este trabalho teve como objetivo revisar os estudos da literatura, a fim de verificar e avaliar os benefícios dos recursos fisioterapêuticos no tratamento e na prevenção do linfedema pós-mastectomia. Metodologia: Foi realizado o levantamento bibliográfico no período de 1980 a 2010, por meio de livros e das bases de dados LILACS, IBECS, MEDLINE, Biblioteca Cochrane e SciELO. Os recursos encontrados foram: fisioterapia complexa descongestiva; compressão pneumática intermitente; drenagem linfática manual; vestuário de compressão; bandagens; drogas; exercícios; cirurgias; laserterapia; cuidados gerais; drenagem linfática mecânica; TENS; auto-massagem; hidroterapia; micro-ondas; ultrassom; termoterapia; balneoterapia; imersão vertical no mercúrio; injeções intra-arteriais de linfócitos autólogos; diuréticos; método Casley-Smith; e estimulação elétrica de alta voltagem (EEAV). Conclusão: A fisioterapia, com seus amplos recursos, ainda é a escolha mais eficiente no tratamento do linfedema pós-mastectomia, pois consegue não só melhorar como manter a funcionalidade da circulação linfática, além de prevenir recidivas de infecções.

INTRODUCTION: The post-mastectomy lymphedema is a chronic, progressive pathological picture, which creates a deficit in the balance of trade in interstitial fluids, resulting mainly from axillary node dissection, radiotherapy and chemotherapy in the armpit.OBJECTIVE: The objective was to review studies of literature, to verify and evaluate the benefits of physical therapy resources for treatment and prevention of post-mastectomy lymphedema. METHODOLOGY: The literature review was conducted in the period 1980-2010, through books and databases LILACS, IBECS, MEDLINE, Cochrane Library and SciELO. The resources were: physiotherapy complex decongestive; intermittent pneumatic compression; manual lymphatic drainage; compression garments; bandages; drugs; exercise; surgery; laser therapy; general care; lymphatic drainage mechanics; TENS;, self-massage; hydrotherapy; microwave; ultrasound; thermotherapy; balneotherapy; vertical immersion in mercury; intra-arterial injections of autologous lymphocytes; diuretics; Casley-Smith method; and high voltage electrical stimulation (HVES). CONCLUSION: Physiotherapy with its extensive resources is still the most efficient choice in the treatment of post-mastectomy lymphedema, for it can improve not only how to maintain the functionality of the lymphatic circulation, and to prevent recurrence of infections.

Disease-Related Stress Experienced by Women with Mastectomy: Q Methodology / 여성건강간호학회지

PURPOSE: To identify the type of disease-related stress experienced by women who received mastectomy for breast cancer using Q methodology. METHOD: Q sample included 30 statements obtained from literature and interviews with women with mastectomy. P sample consisted of 22 patients with mastectomy. The data were collected from November to December 2002 and analyzed using QUANL program. RESULT: Four types of disease-related stress experienced by women with mastectomy were found. Type 1 was manifested for a short duration following surgery and characterized by lowered self-esteem, feelings of emptiness and depression because of impaired body image. Type 2 was characterized by declined physical strength, resulting in frequent fatigue in the daily life and less intimate relationship with spouse. Type 3 was manifested by perfectionists with strong sense of self-pride who received or considered breast reconstruction surgery. Type 4 was reported by those who had long period of post-surgery. This type reported a strong sense of discomfort for wearing an artificial breast but didn't show any intention of trying breast reconstruction surgery. CONCLUSION: Women with mastectomy were found to experience different type of disease-related distress. Therefore, nurses should assess the type of stress the patient experiences following a mastectomy to provide appropriate nursing care.

A Study on Health Promoting Behavior In Post-Mastectomy Patients / 성인간호학회지

The purpose of this study was to examine the relationship among perceived health status, self-esteem, self-efficacy and health promoting behavior, and to determine the predictors of health promoting behavior in post-mastectomy patients. The study, a descriptive correlational study, was done with structural questionnaires. A total of 51 post-mastectomy subjects from C university hospital in Kwang-ju, South Korea completed mail-in self-reporting questionnaires during a three month period from March to June, 1999. The data were collected using Lawstone's(1982) perceived health status scale, Rosenberg's(1965) self-esteem scale, the modified self-efficacy scale(Shere et al, 1982), and the modified health promoting lifestyle profile (Walker et al, 1987). The data obtained were analyzed according to percentage, mean and standard deviation, principal component analysis, varimax rotation, t-test, ANOVA, Pearson's correlation, and stepwise multiple regression. The results were as follows: 1. The health promoting behavior measurement resulted in six factors. Each factor was labelled as follows: self-actualization, nutrition, stress management, exercise, health responsibility and interpersonal support. The total percent of variance explained by the six factors was 58.4%. 2. The mean score of health promoting behavior was 85.92(range 58~117). The scores of six factor were nutrition 3.20, self-actualization 2.59, stress management 2.58, interpersonal support 2.58, health responsibility 2.49, and exercise 2.34 on a four point scale. 3. When the score of health promoting behavior factors were compared by general characteristics. FactorI: self-actualization, differed significantly by the frequency of pregnancy (F=3.06, p=.037). FactorII: nutrition differed significantly by drinking experience(t=-2.26, p=.028) and the pre- or post stage of menopause(F=2.69, p=078). FactorIII: stress management differed significantly depending on regularity of mensturation(t=-2.12, p= .042). FactorIV: exercise differed significantly by type of religion (F=2.49, p=.072), marital status(F=5.03, p=.010), and feeding type (F=2.64, p=.036). FactorV: health responsibility differed significantly by regularity of mensturation(t=2.18, p=.037). 4. The total health promoting behavior score was significantly related to self-esteem and perceived health status(r=.610, p.006; r= .378, p=.006). The score of self-actualization also corresponded with self-esteem and perceived health status(r=.556, p=.001; r=.343, p=.013). 5. The predictor to explain the score of health promoting behavior was self-esteem, which accounted for 37.1% of the total variance. The predictor to explain the score of self-actualization was self-esteem, which accounted for 30.9% of the total variance. The score of nutrition was primarily affected by both premenopause and drinking experience, which accounted for 13.1% and 9.5% respectively. Finally, the score of exercise was dictated by marriage, Buddhism, no experience of breast feeding, which accounted for 17%, 9.8%, & 5.2% respectively. In conclusion, self-esteem is the main predictor for health promoting behavior in post-mastectomy women. These findings suggest a need for nursing strategies which promote self-esteem in such patients.