Surgical Timing Considerations in osteosarcoma patients with autism spectrum disorder: A systematic review of indirect evidence and a conceptual framework
Kazuhiko Hashimoto, Shuniji Nishimura, Hiroki Tan, Koji GotoPurpose
Direct evidence on optimal surgical timing in patients with osteosarcoma and coexisting autism spectrum disorder (ASD) is lacking. We systematically reviewed the available indirect evidence and developed a conceptual framework to support individualised multidisciplinary decision-making.
Methods
PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar were searched from database inception through 7 January 2026, across three domains: osteosarcoma surgical timing, perioperative care in ASD, and cancer treatment adaptations in ASD and related neurodevelopmental populations. Findings were synthesised narratively in accordance with PRISMA 2020 and interpreted according to evidentiary directness and methodological quality.
Results
Of 1,327 records screened, 156 full-text articles were assessed and 32 studies were included (10 on osteosarcoma surgical timing, 17 on ASD perioperative care, and 5 on cancer treatment in ASD and related neurodevelopmental populations). No study directly evaluated surgical timing and outcomes in patients with both conditions. In general osteosarcoma cohorts, prolonged treatment intervals were associated with adverse outcomes, including reduced tumour necrosis when the chemotherapy–surgery interval exceeded four weeks (p=0.03) and poorer survival when adjuvant chemotherapy was resumed late after surgery.
Conclusions
Current evidence does not support ASD-specific surgical timing thresholds in osteosarcoma. We propose a three-domain conceptual framework that keeps oncologic urgency primary while using ASD-informed adaptations—such as early multidisciplinary planning, structured preoperative preparation, sensory-adapted environments, and individualised anaesthesia and communication planning—to support timely and feasible care.