Improving the Understanding of Late Effects of Testicular Cancer in Adolescent and Young Adult Survivors: TRANSCEND-XR

Background: Testicular cancer (TC) is the most common malignancy amongst adolescents and young adults (AYAs) aged 15–39 years assigned male at birth. Survivors often experience late effects of treatment and report unmet supportive care needs. Objectives: To present the protocol for the TRANSCEND-XR project (TesticulaR cANcer late effects and unmet Supportive CarE NeeDs of AYA survivors using eXtended Reality). Materials and Methods: TRANSCEND-XR aims to ethically co-create, test, and scale up in a clinical setting an innovative digital intervention to increase AYA TC survivors’ knowledge of the late effects of TC treatment and address their unmet supportive care needs using XR. Delivered by a consortium of 15 partners across 12 European countries, guided by the Medical Research Council's framework for complex interventions, and funded by the European Union, TRANSCEND-XR is structured into three phases: co-creation and validation (Phase 1); implementation and evaluation (Phase 2); and impact, guideline development, policy, dissemination, and exploitation (Phase 3). Results: Phase 1 involves a cross-sectional survey of 500 AYA TC survivors to assess late effects and care needs as well as participatory World Café sessions with healthcare professionals, survivors, and care partners (n = 200) to co-design the TRANSCEND-XR intervention. Phase 2 includes a multicentre, single-arm phase 2 pilot trial (n = 15) across three clinical sites in three countries evaluating intervention feasibility, and a multicentre pragmatic randomised controlled phase 3 trial (n = 230) across eight clinical sites in seven countries, evaluating improvements in knowledge of late effects, cost-effectiveness, implementation, and ethical considerations. Phase 3 focuses on guideline development, policy influence, and strategic dissemination to ensure long-term sustainability and integration into European healthcare systems. Discussion: TRANSCEND-XR aims to transform survivorship care for AYA TC survivors through a co-created, scalable XR intervention. Its interdisciplinary approach promotes scientific rigour, stakeholder engagement, and policy relevance to improve long-term outcomes and quality of life. Conclusion: TRANSCEND-XR has the potential to advance survivorship care standards for AYAs with TC whilst providing a model for future digital health interventions in oncology.