***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose The purpose of this study was to assess whether incorporation of an original reproductive health assessment and algorithm into breast cancer care helps providers appropriately manage patient reproductive health goals and to follow laboratory markers for fertility and correlate these with menstruation . Methods This prospect i ve observational pilot study was set in an urban , public hospital . Newly diagnosed premenopausal breast cancer patients between 18 and 49 years old were recruited for this study prior to chemotherapy initiation . As the intervention , these patients received a reproductive health assessment and care per the study algorithm at 3-month intervals for 24 months . Blood sample s were also collected at the same time intervals . The main outcome measures were to assess if the reproductive health management was consistent with patient goals and to track any follicle-stimulating hormone ( FSH ) and thyroid-stimulating hormone ( TSH ) level changes throughout treatment and post-treatment period . Results Two patients were pregnant at study initiation . They received obstetric consultations , opted to continue pregnancies , and postpone treatment ; both delivered at term without complications . One woman desired future childbearing and received fertility preservation counseling . All women received family planning consultations and received/continued effective contraceptive methods . Seventy-three percent used long-term contraception , 18 % remained abstinent , and 9 % used condoms . During chemotherapy , FSH rose to menopausal levels in 82 % of patients and TSH rose significantly in 9 % . While 82 % of women experienced amenorrhea , 44 % of these women resumed menstruation after chemotherapy . Conclusions The assessment and algorithm were useful in managing patients ’ reproductive health needs . Chemotherapy-induced endocrine disruption impacted reproductive health BACKGROUND A growing body of literature indicates that adolescents with chronic conditions are as likely , or more likely , to take risky behaviours than their healthy peers . The objective of this research was to assess whether adolescents with chronic illness in Catalonia differ from their healthy peers in risk-taking behaviour . METHODS Data were drawn from the Catalonia Adolescent Health data base , a survey including a r and om school-based sample of 6952 young people , aged 14 - 19 years . The index group ( IG ) included 665 adolescents ( 450 females ) reporting several chronic conditions . The comparison group ( CG ) comprised 6287 healthy adolescents ( 3306 females ) .  Personal , family and school-related variables were analysed to ensure comparability between groups . Sexual behaviour , drug use ( tobacco , alcohol , cannabis , cocaine and synthetic drugs ) and perception of drug use among peers and in school were compared . Analysis was carried out separately by gender . chi-square , Fisher 's and Student 's tests were used to compare categorical and continuous variables . RESULTS The prevalence of chronic conditions was 9.6 % , with females showing a higher prevalence than males . The IG showed similar or higher rates of sexual intercourse and risky sexual behaviour . For most studied drugs , IG males reported slightly lower rates of use than CG males , while IG females showed higher rates for every drug studied . No differences were found in the perceptions of drug use among peers or in their school . CONCLUSIONS Similar to previous research , chronically ill adolescents in our sample are as likely , or more likely , to take risky behaviours than their healthy counterparts and should receive the same anticipatory guidance OBJECTIVE : To compare rates of contraception between reproductive-aged cancer survivors and women in the general U.S. population . Among survivors , the study examined factors associated with use of  contraception and emergency contraception . METHODS : This study analyzed enrollment data from an ongoing national prospect i ve cohort study on reproductive health after cancer entitled the Fertility Information Research Study . We compared current contraceptive use in survivors with that of the general population ascertained by the 2006–2010 National Survey for Family Growth . Log-binomial regression models estimated relative risks for characteristics associated with use of contraception , World Health Organization tiers I – II ( sterilization and hormonal ) contraceptive methods  , and  emergency contraception  in survivors . RESULTS : Data from 295 survivors ( mean age 31.6±5.7 years , range 20–44 years ) enrolled in this prospect i ve study ( 85 % response rate ) were examined . Age-adjusted rates of using tiers I – II contraceptive methods were lower in survivors than the general population ( 34 % [ 28.8–40.0 ] compared with 53 % [ 51.5–54.5 ] , P<.01 ) . Only 56 % of survivors reported  receiving family planning services  ( counseling , prescription or procedure related to birth control ) since cancer diagnosis . In adjusted analysis , receipt of family planning services was associated with both increased use of tiers I – II contraceptive methods ( relative risk 1.3 , 95 % confidence interval [ CI ] 1.1–1.5 ) and accessing emergency contraception  ( relative risk 5.0 , 95 % CI 1.6–16.3 ) in survivors . CONCLUSION : Lower rates of using tiers I – II contraceptive methods were found in reproductive-aged cancer survivors compared with the general population of U.S. women .  Exposure to family planning services across the cancer-care continuum may improve contraception use among these women . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT01843140 . LEVEL OF EVIDENCE : Purpose To up date the Potentially Curable Pancreatic Cancer : American Society of Clinical Oncology Clinical Practice Guideline published on May 31 , 2016 . The October 2016 up date focuses solely on new evidence that pertains to clinical question 4 of the guideline : What is the appropriate adjuvant regimen for patients with pancreatic cancer who have undergone an R0 or R1 resection of their primary tumor ? Methods The recently published results of a r and omized phase III study prompted an up date of this guideline . The high quality of the reported evidence and the potential for its clinical impact prompted the Expert Panel to revise one of the guideline recommendations . Results The ESPAC-4 study , a multicenter , international , open-label r and omized controlled phase III trial of adjuvant combination chemotherapy compared gemcitabine and capecitabine with gemcitabine monotherapy in 730 evaluable patients with resected pancreatic ductal adenocarcinoma .  Median overall survival was improved in the doublet arm to 28.0 months ( 95 % CI , 23.5 to 31.5 months ) versus 25.5 months ( 95 % CI , 22.7 to 27.9 months ) for gemcitabine alone ( hazard ratio , 0.82 ; 95 % CI , 0.68 to 0.98 ; P = .032 ) . Grade 3 and 4 adverse events were similar in both arms , although higher rates of h and -foot syndrome and diarrhea occurred in patients r and omly assigned to the doublet arm . Recommendations All patients with resected pancreatic cancer who did not receive preoperative therapy should be offered 6 months of adjuvant chemotherapy in the absence of medical or surgical contraindications . The doublet regimen of gemcitabine and capecitabine is preferred in the absence of concerns for toxicity or tolerance ; alternatively , monotherapy with gemcitabine or fluorouracil plus folinic acid can be offered . Adjuvant treatment should be initiated within 8 weeks of surgical resection , assuming complete recovery . The remaining recommendations from the original 2016 ASCO guideline are unchanged To learn whether female cancer survivors are more likely to terminate a pregnancy by choice than other women , the occurrence of induced abortions was determined in a population -based cohort of 1688 childhood cancer survivors .  Proportion ratios ( PRs ) were estimated from the ratio of the proportion of pregnancies that result ed in induced abortions among the survivors ( or 16 700 r and omly selected population control subjects ) to the proportion among 2737 sisters of the survivors . The proportion of induced abortions among survivors ( 292 of 1479 [ 19.7 % ] ) was marginally higher but not statistically significantly different from that among sisters ( 961 of 5092 [ 18.9 % ] ; PR = 1.08 , 95 % confidence interval [ CI ] = 0.96 to 1.22 ) and similar to that of the population control subjects ( 5505 of 27 989 [ 19.7 % ] ; PR = 1.07 , 95 % CI = 1.01 to 1.14 ) . Survivors were not more likely than sisters and population control subjects to elect a second-trimester abortion because of physical and mental conditions or fetal abnormalities PURPOSE This study aim ed to assess sexual behaviors , sexual orientation , pregnancy , and abuse history among adolescents with and without chronic conditions . METHODS Analyses were based on a statewide survey of 36,284 young people in the 7th through 12th grade s for analytic purpose s ; subsets were defined using a specialized cohort design including adolescents with visible and nonvisible conditions plus controls . Principle outcome measures included self report of ever having sexual intercourse , age of sexual debut , reasons for not having intercourse , ever causing or having a pregnancy , ever having a sexually transmitted disease ( STD ) , contraceptive use and reasons for their nonuse , history of sexual abuse , and sexual orientation . RESULTS No differences were evident between adolescents with and without chronic conditions in the proportion ever having intercourse , age of sexual debut , pregnancy involvement , patterns of contraceptive use , or sexual orientation . No differences were evident among girls or boys with visible compared with invisible conditions . A significantly greater proportion of girls and boys with invisible conditions than controls reported a history of sexual abuse . More index boys than controls reported ever having an STD , whereas more girls with visible conditions than controls reported this . CONCLUSIONS Adolescents with chronic conditions are at least as sexually involved as their peers , and significantly more likely to have been sexually abused . Visibility of chronic conditions does not appear to affect the sexual behaviors of adolescents . The need for comprehensive sexuality education in this population is high , and discussion of sexuality , contraception and abuse must be part of st and ard psychosocial assessment and anticipatory guidance for all teenagers , including those with chronic conditions 
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FINDINGS : Women with cancer  experience unintended pregnancy and abortion throughout their care .
Not all women reported receiving contraception counseling , and many reported inconsistencies between contraception counseling desired and received .
A prominent theme was uncertainty about fertility status .
Use of highly effective contraceptive methods was low to moderate in eight patient population