ObjectivesWomen with breast cancer have different needs that are various in perceived importance and satisfaction. This study aimed to examine the relationship among perceived needs satisfaction, perceived needs importance with health-related quality of life (HRQoL) in women with breast cancer and determine the intermediary role of perceived needs importance in the relationship between perceived needs satisfaction and HRQoL.DesignCross-sectional design.SettingTwo tertiary level hospitals in Shaanxi Province, China.ParticipantsWomen newly diagnosed with breast cancer were recruited.Outcome measuresThe Needs Self-Rating Questionnaire for Breast Cancer and the Medical Outcomes Study 36-item Short-Form Health Survey V. 2.0 were used for data collection regarding perceived needs satisfaction, perceived needs importance and HRQoL.ResultsA total of 359 valid questionnaires were collected. The perceived needs importance was negatively associated with physical component summary (PCS) (b=−0.067, p=0.024) and mental component summary (MCS) (b=−0.185, p<0.001). On the contrary, perceived needs satisfaction was positively associated with PCS (c′=0.005, p=0.843), although not statistically significant. Perceived needs satisfaction was positively associated with MCS (c′=0.194, p<0.001) and perceived needs importance (a=0.458, p<0.001). Furthermore, the perceived needs importance suppressed the relationship between perceived needs satisfaction and PCS (a*b=−0.031; 95% CI −0.058 to –0.004) and the relationship between perceived needs satisfaction and MCS (a*b=−0.085; 95% CI −0.138 to –0.043).ConclusionFor women with breast cancer, higher perceived needs satisfaction is associated with higher HRQoL. However, higher perceived needs importance would be conversely associated with lower HRQoL by suppressing the positive association of perceived needs satisfaction with HRQoL. Healthcare providers should pay more attention to those who have high perceived needs importance but low perceived needs satisfaction and fulfil the important needs.