Strengthening teen brain resilience using music (STRUM) during cancer treatment: a pilot feasibility trial

The National Cancer Institute awarded Mayo Clinic Arizona $319,195 on September 1, 2026, under the Cancer Treatment Research program (CFDA 93.395) to conduct a pilot feasibility trial of STRUM (Strengthening Teen Brain Resilience Using Music), a 10-week virtual music therapy intervention for adolescents undergoing radiation therapy for cancer.

Up to 50 percent of adolescents receiving radiation therapy experience radiation-induced cognitive decline, with intellectual functioning plateauing 10–20 IQ points below expected levels. STRUM addresses the absence of evidence-based interventions to proactively strengthen brain resilience in teens at risk for this decline. The intervention, led by board-certified music therapists, uses structured ukulele training to harness music's neuroplastic and psychosocial benefits to enhance cognition, emotional regulation, and self-efficacy in participants undergoing initial radiation therapy.

The pilot will recruit 30 participants ages 12–17 years in a single-group repeated-measures design to determine the feasibility of STRUM, including participant recruitment, retention, adherence, and outcome completion in the context of teens receiving radiation therapy. Secondary aims assess the acceptability of STRUM and its delivery. This planning study precedes a future Phase II randomized controlled trial to evaluate STRUM's efficacy in improving brain resilience.

Performance takes place in Scottsdale, Arizona. The award period extends through August 31, 2029.

Abstract

Clinical problem: up to 50% of adolescents treated with radiation therapy for cancer experience radiation- induced cognitive decline (RICD) with intellectual functioning plateauing 10-20 IQ points below expected levels. These late effects compromise brain resilience-the ability to preserve or restore cognitive and emotional functioning despite stressors. No current evidence-based interventions exist to proactively strengthen brain resilience in teens at risk for RICD. Overall objective: the project's objective is to evaluate strum (strengthening teen brain resilience using music), a 10-week, virtually delivered active music therapy intervention. Led by board-certified music therapists, strum uses structured ukulele training to harness music's neuroplastic and psychosocial benefits. Strum aims to proactively strengthen brain resilience in teens undergoing radiation therapy by enhancing key constructs pertinent to brain resilience (i.e., cognition, emotional regulation, and self-efficacy). Need for planning study: the primary aim for our future phase II randomized controlled trial is to evaluate strum's efficacy in improving brain resilience among teens undergoing initial radiation therapy. Before efficacy testing, key planning issues must be addressed: the feasibility of recruiting and retaining teens undergoing initial radiation and the acceptability of a musical instrument training intervention in this population are unknown. R34 specific aims: the primary aim is to determine the feasibility of strum, including participant recruitment, retention, adherence, and outcome completion in the context of teens receiving radiation therapy for cancer treatment. Secondarily, we will assess the acceptability of strum and its delivery. Methods: using a single-group repeated measures design we recruit 30 participants ages 12-17 years receiving radiation therapy for cancer treatment at mayo clinic arizona to the virtual strum intervention. Participants will receive ten weekly 30-minute virtual ukulele lessons and complete assessments of cognition, resilience, emotional regulation, self-efficacy, anxiety, and depression at baseline, six, twelve, and twenty weeks. Recruitment and retention metrics will be used to evaluate feasibility. The acceptability of intervention measure and exit interviews will evaluate the strum intervention's acceptability. Expected outcomes: this project will establish the feasibility and acceptability of strum and provide essential information to refine its delivery. The findings will yield preliminary data on brain resilience outcomes and generate effect size estimates to inform a phase II efficacy trial.