PROJECT SUMMARY Studies evaluating the effects of natural disasters on cancer outcomes and disparities are scarce, and to the study team’s knowledge; none have examined the impact of exposure to multiple disasters, particularly in ethnic minority groups. Currently, the team is expanding assessments to include the impact of COVID-19 and the earthquakes’ secondary hazards (social isolation, unemployment, healthcare services disruption, structural damage) on stress biomarkers and changes in multilevel determinants of health. The proposed supplement will complement the scope of the parent R21 (1R21MD013674) by: 1) expanding recruitment to include additional cancer patients (+75) and controls (+75) who were exposed to Maria, the 2020 earthquakes, and the COVID-19 pandemic; 2) identifying patients’ unmet psychological and medical needs resulting from the aftermath of the 2020 earthquakes and the COVID-19 pandemic, and; 3) examining the impact of Maria, the earthquakes, and the COVID-19 pandemic on multilevel factors relevant to health outcomes. The proposed supplement project will shift current research paradigms in health outcomes after natural disasters by exploring the physiological effects of extreme stressors on biological processes known to affect cancer progression and comorbid conditions, including inflammation and stress hormones. By expanding the parent grant’s scope to include the 2020 earthquakes and COVID-19 pandemic, the study team will increase the understanding of the effects of multiple disaster stressors.