Project Summary/Abstract Severe storms, whether hurricanes or other storms with significant wind/precipitation, affect millions of Americans each year, disrupt the delivery of healthcare, and increase the risk for health complications. While severe storms may impact the care and outcomes of any cancer, addressing its impact on patients with breast cancer, a highly prevalent cancer with a good overall survival when treated with high-quality care, is of high public health significance. The primary research objective of this proposal is to recognize treatment disruption and adverse health outcomes experienced by patients with breast cancer and to identify and prioritize strategies to respond to health needs. In this study, we employ a mixed methods framework to accomplish the following aims: (Aim 1) To assess the impact of severe storms on breast care, acute care services, and mortality among patients with breast cancer, identify the most vulnerable populations, and evaluate potential mediators for the three outcomes; (Aim 2) To describe disruptions in breast cancer care, community concerns, perceived care barriers, and strategies to mitigate care disruptions and respond to health needs following storms using depth interviews of key stakeholders; (Aim 3) To identify and prioritize targeted interventions to mitigate disruptions in breast cancer care and respond to post-storm health needs through Delphi methods and community engagement. I am supported by a mentorship team with expertise in oncology, climatology, health services research, geospatial analysis, mixed methods, and disaster preparedness. I will link storm data, including wind speed, flooding, and power outage, with breast databases to quantify the impact of severe storms on the care and outcomes, identify mediators on the causal pathway and create geospatial maps to identify impacted communities and health systems. Then I will conduct depth interviews with diverse stakeholders in cancer care and disaster prep