Helping Young People With Testicular Cancer Using Virtual and Extended Reality

Testicular cancer is a rare cancer, but it mainly affects adolescents and young adults. Today, thanks to the effectiveness of treatments, the vast majority of patients are cured. However, even after treatment has ended, many young people continue to live with long-term consequences, known as "late effects." These effects can vary widely and may include persistent fatigue, pain, hormonal or sexual problems, psychological difficulties such as anxiety or stress, as well as impacts on social life, relationships, education, or professional life.

These difficulties are often poorly understood by patients themselves, sometimes insufficiently addressed during medical follow-up, and may last for several years. Many young people feel inadequately informed, isolated, or unsure about when and how to seek help. Although essential, standard medical follow-up does not always fully address all of these supportive care needs.

It is within this context that the TRANSCEND-XR project was created. TRANSCEND-XR is a European research project coordinated by Gustave Roussy, aiming to develop and evaluate an innovative digital tool based on extended reality (XR) for adolescents and young adults treated for testicular cancer.

TRANSCEND-XR seeks to help young survivors better understand their disease and the treatments they have received, learn about potential long-term effects, recognize symptoms that require medical attention, and adopt health-promoting behaviors. The tool also aims to strengthen their autonomy, confidence, and ability to take an active role in their own follow-up care.

The project is carried out in two main phases. A first pilot study, conducted with a small number of participants across several countries, assesses the feasibility, usability, and acceptability of the tool and allows it to be improved based on patient feedback. A second phase involves a larger clinical study comparing young people who use the TRANSCEND-XR tool with others who receive standard follow-up care only. Researchers will evaluate, in particular, the impact on patients' knowledge, quality of life, supportive care needs, help-seeking behavior, and engagement in long-term follow-up.

Beyond medical outcomes, TRANSCEND-XR also focuses on user experience, digital accessibility, ethical considerations, and equity, in order to offer a solution that is truly adapted to young people's needs and everyday practices.

In summary, TRANSCEND-XR aims to sustainably improve information, well-being, and quality of life for young survivors of testicular cancer, using innovative digital tools to better address the challenges of life after cancer.

Inclusion criteria

• Any person assigned male at birth who is diagnosed with stage I-III TC (germ cell tumour of the testicles).
• Aged between 15 and 39 years at the time of study inclusion.
• Completed curative treatment comprising of at least one standard treatment modality (surgery, chemotherapy and/or radiotherapy) for treatment of their cancer. A maximum of 9 months from the end of curative treatment will be allowed.
• Permitted treatment modalities:

• Localised disease: orchiectomy with or without chemotherapy and/or radiotherapy.
• Metastatic disease: orchiectomy and chemotherapy or radiotherapy or retroperitoneal surgery, or a combination of aforementioned treatments. First-line treatment only allowed.
• Willing and able to provide a valid and signed informed consent and/or assent, as appropriate.
• ECOG performance status 0-2.
• Patients accept to use personal smartphone
• Patients able to read and understand the local language

Exclusion criteria

• Non-testicular germ cell tumours (e.g., mediastinal primary or retroperitoneal primary tumours).
• Non-germ cell TC.
• Previous chemotherapy, radiotherapy, or surgery for TC other than that allowed in IC 4.
• History of contralateral TC.
• Any illness that would prevent the AYA TC survivor from giving a valid and signed informed consent, as assessed by the investigator.
• Any illness that might be exacerbated by the use of an XR digital tool, as assessed by the investigator, including history of severe motion sickness, brain lesions and epilepsy.
• Uncontrolled medical condition such as uncontrolled infection, uncontrolled diabetes mellitus or cardiac disease (including but not limited to grade 2 or higher cardiac failure, arrythmia, unstable angina, history of myocardial infract in the 6 months which, in the opinion of the treating physician, would influence the assessment of long-term side effect of TC treatment.
• AYA TC survivors with a "currently active" second malignancy other than non-melanoma skin cancers, superficial non-invasive (pTa or pTis) TCC of the bladder, or intratubular germ cell neoplasia. Patients are not considered to have a "currently active" malignancy if they have completed therapy and are free of disease for ≥ 3 years.
• Chemotherapy or radiotherapy for malignant disease other than TC within the past 3 years.