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.