Background/Objectives: The preoperative improvement of patients’ functional capacity (prehabilitation) has gained attention in the surgical field, especially for colorectal cancer (CRC) patients. Despite the recognized benefits of prehabilitation programs, patients’ motivation to participate in and adhere to them remains a significant challenge. Several studies reported difficulties in recruiting participants and low adherence rates. This systematic review explored patients’ motivation for participation and adherence to prehabilitation programs for colorectal cancer surgery. Methods: A systematic search was conducted in the PubMed (MEDLINE), Embase, Cochrane, CINAHL, and Web of Science databases. Eligible studies included clinical trials published from inception until December 2024, written in English or Dutch, describing barriers and/or motivators affecting patient participation and adherence in prehabilitation programs. Results: A total of 89 studies, including 34 randomized controlled trials, were included. In total, 13,383 patients were included, with 7162 in the prehabilitation cohort. Participation rates ranged from 0 to 99.4%, and adherence rates ranged from 15% to 100%. Factors limiting participation included logistical issues and a busy schedule. Professional guidance, peer support, and regaining a sense of control improved adherence. Medical reasons, conflicting obligations, and intensive exercise limited adherence. Conclusions: This systematic review analyzed the current literature on participation and adherence in prehabilitation programs for colorectal cancer surgery patients. Overcoming logistical barriers and patient concerns through flexible, patient-centered approaches may improve participation and adherence. Future research should focus on large-scale randomized controlled trials, diverse healthcare settings, and strategies to enhance engagement with prehabilitation programs.

An accumulating body of research suggests that an accelerating enhanced recovery after colon surgery protocol is beneficial for patients, however, to obtain these effects, adherence to all elements of the protocol is important. The implementation of complex interventions, such as the Enhanced Recovery After Surgery protocol (ERAS), and their strict adherence have proven to be difficult. The same challenges can be expected in the implementation of the accelerated Enhanced Recovery Pathways (ERPs). This study aimed to understand the perspectives of both healthcare professionals (HCPs) and patients on the locally studied acCelerated enHanced recovery After SurgEry (CHASE) protocol. For this mixed-method study, HCPs who provided CHASE care and patients who received CHASE care were recruited using purposive sampling. Ethical approval was obtained by the Medical Ethical Committee of the Zuyderland Medical Centre (NL71804.096.19, METCZ20190130, October 2022). Semi-structured, in-depth, one-on-one interviews were conducted with HCPs (n = 13) and patients (n = 11). The interviews consisted of a qualitative and quantitative part, the protocol evaluation and the Measurement Instrument or Determinant of Innovations-structured questionnaire. We explored the perspectives, barriers, and facilitators of the CHASE protocol implementation. The interviews were audiotaped, transcribed verbatim and analysed independently by two researchers using direct content analysis. The results showed that overall, HCPs support the implementation of the CHASE protocol. The enablers were easy access to the protocol, the relevance of the intervention, and thorough patient education. Some of the reported barriers included the difficulty of recognizing CHASE patients, the need for regular feedback, and the updates on the implementation progress. Most patients were enthusiastic about early discharge after surgery and expressed satisfaction with the care they received. On the other hand, the patients sometimes received different information from different HCPs, considered the information to be too extensive and few experienced some discomfort with CHASE care. Bringing CHASE care into practice was challenging and required adaptation from HCPs. The experiences of HCPs showed that the protocol can be improved further, and the mostly positive experiences of patients are a motivation for this improvement. These results yielded practical implications to improve the implementation of accelerated ERPs.

E13059 Background: Alpelisib (A) is a PI3Kα-selective inhibitor and degrader which, in combination with fulvestrant, has been approved for the treatment of hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2-), PIK3CA-mutated advanced breast cancer (ABC). Hyperglycemia is the most commonly observed adverse event of A. A pooled analysis of X2101 AND SOLAR-1 trials showed the association between five baseline patient characteristics (age, fasting plasma glucose (FPG), glycated haemoglobin, body mass index (BMI) and blood monocyte count (BMC)) and the development of A-induced hyperglycaemia (HG). We examined the association between baseline factors and the A-induced HG grade (G) ≥2 in a real-world setting. Methods: We performed the retrospective observational study and included patients (pts) with HR+, HER2-, PIK3CA-mutated metastatic breast cancer who received A + fulvestrant between Oct 18, 2019, and Oct 13, 2022, at the Institute of Oncology Ljubljana. Electronic records were reviewed. Baseline age, FPG, glycated haemoglobin, BMI and BMC before the start of A therapy and glucose levels during treatment with A were collected. Random plasma glucose values (RPG) were used for HG grading according to CTCAE V. The chi-square test was used to determine the association between the baseline characteristics and A-induced HG G ≥2. Results: Thirty-one female pts were included in the analysis. The median follow-up was 21 months, and the median duration of A treatment was 5.4 months. The baseline pts characteristics were as follows: median age 58 years (range 33–80), median FPG 5.6 mmol/L (range 3.10–8.6), median BMI 21.7 kg/m² (range 18.7–30.4), and median BMC was 10.3% (range 5.3–16.6). Baseline glycated haemoglobin values were only known for 58.1% of patients, so we did not further analyse them. The highest HG grades during treatment with A were as follows: G0 in 14 pts (45.2%), G1 in 5 pts (16.1%), G2 in 6 pts (19.4%), G3 in 6 pts (19.4 %). The calculated cut-off values associated with A-induced HG ≥2 were: age above 65 years, FPG above 5.9 mmol/L and BMC more than 11.5. None of the BMI cut-off values was associated with HG G≥2. Association between the baseline age, FPG and BMC and A-induced HG G≥2. Conclusions: Age over 65 years, FPG more than 5.9 mmol/L and BMC more than 11.5% have a statistically significant higher probability for A-induced HG G≥2. Therefore, these patients need more frequent blood glucose measurements, lifestyle adjustments and early treatment with metformin and/or other oral glucose-lowering agents. [Table: see text]

Hereditary Neuropathy with Liability to Pressure Palsies (HNPP) has long been described as a disorder of "painless palsies," shaping diagnostic and therapeutic paradigms. Increasing evidence suggests this characterization underestimates the true burden of pain in HNPP. We systematically reviewed literature to examine how pain recognition and characterization in HNPP have evolved. MEDLINE, Embase, Web of Science, and CENTRAL were searched from database inception through August 2025 for studies explicitly reporting pain status. Data on pain prevalence, assessment methods, temporal trends, and associated clinical features were extracted. Studies were grouped into three eras reflecting diagnostic advances: early (≤1990; clinical diagnosis only), modern (1990-2015; introduction of genetic testing), and recent (≥2015; widespread use of genetic panels). Fifty-three studies comprising 655 patients met inclusion criteria. Reported pain prevalence increased over time, from reinforcing a "painless" paradigm in early studies to 34% in modern studies and 56% in recent studies. Recent studies more frequently identified complex neuropathic pain phenotypes. Only four studies (7.5%) used validated pain assessment tools, yet consistently reported higher prevalence and greater symptom complexity. HNPP is not uniformly painless. Pain is common, clinically relevant, and multifactorial, highlighting the need for standardized pain assessment to guide management.

PTEN hamartoma tumour syndrome (PHTS) is characterized by a germline PTEN mutation and a substantial increase in lifetime breast cancer risk to 85% with lower age at first diagnosis. Despite the availability of agents targeting PTEN-regulated PI3K/AKT/mTOR pathway, there are currently no approved treatments for PHTS patients with cancer. This is the first report of a patient with triple-negative metaplastic breast cancer and PHTS in the literature. We present an exceptional response of this aggressive stage IV tumour in a 34-year-old woman with PHTS to treatment with the novel AKT1-3 inhibitor, TAS-117. Despite previous rapid progression and resistance to multi-agent chemotherapy and radiotherapy, disease stabilisation was ongoing at 3.8 years. Cell-free DNA analysis of blood samples at baseline and during treatment with TAS-117 revealed a complete marker response to treatment. Therapy has been well tolerated, and the patient continues the therapy without severe adverse events, dose reduction, or treatment interruptions. These findings support further investigation of targeted interventions for malignancies developing in the context of PHTS.