Background: Breast cancer continues to be the most frequently diagnosed cancer in women worldwide. Its diagnosis and treatment often results in a stressful life event and high levels of psychological distress. Pain, hopelessness, and suicidal ideation are common in patient with breast cancer. Aim of the study: To identify self-efficacy, pain and suicidal thoughts among women with breast cancer undergoing chemotherapy .Subjects and method: Research design: A Cross sectional descriptive design was used. Setting: The present study was done at oncology outpatient clinic at Zagazig university hospitals, Subjects: 305 patients were selected for the study by systemic random sampling technique. Tools of data collection: Three tools were used, the first tool composed of two parts: socio-demographic data sheet, and Symptom-Management Self-Efficacy Scale-Breast Cancer The second tool was the Numerical Rating Scale and the third tool was Suicide Probability Scale. Results: The study findings showed that 51.1% of breast cancer women had low score regarding self-efficacy, 68.2% had moderate pain and 54.8%had moderate score regarding suicide probability .Higher percentage of them who had severe score of suicide probability and severe pain aged 40-60 years, were not working, had moderate education, were widow, had not enough income and at fourth degree of cancer. The findings also indicated that there was statistically significant relation between total score of self-efficacy, pain intensity and suicide probability. Conclusions: The Study results proven that more than half of breast cancer patients had low score regarding self-efficacy and moderate score regarding suicide probability. Additionally, more than two third of breast cancer patients had moderate pain. Moreover, reduced self-efficacy among breast cancer patients is particularly associated with pain experience and current suicidal thoughts. Recommendations: Developing Psycho-educational program focus on preventing suicidal thought, reducing pain and increasing self-efficacy in breast cancer women.