Clinicians have long used lithium to treat manic depression. They have also observed that lithium causes granulocytosis and lymphopenia while it enhances immunological activities of monocytes and lymphocytes. In fact, clinicians have long used lithium to treat granulocytopenia resulting from radiation and chemotherapy, to boost immunoglobulins after vaccination, and to enhance natural killer activity. Recent studies revealed a mechanism that ties together these disparate effects of lithium. Lithium acts through multiple pathways to inhibit glycogen synthetase kinase-3β (GSK3β). This enzyme phosphorylates and inhibits nuclear factors that turn on cell growth and protection programs, including the nuclear factor of activated T cells (NFAT) and WNT/β-catenin. In animals, lithium upregulates neurotrophins, including brain-derived neurotrophic factor (BDNF), nerve growth factor, neurotrophin-3 (NT3), as well as receptors to these growth factors in brain. Lithium also stimulates proliferation of stem cells, including bone marrow and neural stem cells in the subventricular zone, striatum, and forebrain. The stimulation of endogenous neural stem cells may explain why lithium increases brain cell density and volume in patients with bipolar disorders. Lithium also increases brain concentrations of the neuronal markers n-acetyl-aspartate and myoinositol. Lithium also remarkably protects neurons against glutamate, seizures, and apoptosis due to a wide variety of neurotoxins. The effective dose range for lithium is 0.6-1.0 mM in serum and >1.5 mM may be toxic. Serum lithium levels of 1.5-2.0 mM may have mild and reversible toxic effects on kidney, liver, heart, and glands. Serum levels of >2 mM may be associated with neurological symptoms, including cerebellar dysfunction. Prolonged lithium intoxication >2 mM can cause permanent brain damage. Lithium has low mutagenic and carcinogenic risk. Lithium is still the most effective therapy for depression. It "cures" a third of the patients with manic depression, improves the lives of about a third, and is ineffective in about a third. Recent studies suggest that some anticonvulsants (i.e., valproate, carbamapazine, and lamotrigene) may be useful in patients that do not respond to lithium. Lithium has been reported to be beneficial in animal models of brain injury, stroke, Alzheimer's, Huntington's, and Parkinson's diseases, amyotrophic lateral sclerosis (ALS), spinal cord injury, and other conditions. Clinical trials assessing the effects of lithium are under way. A recent clinical trial suggests that lithium stops the progression of ALS.

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e24082 Background: Palliative radiation therapy (PRT) is underutilized in the United States, in part due to misconceptions among patients and other providers about its risks, benefits, and indications. Empowered patients, who are more knowledgeable about how radiation can alleviate cancer-induced symptoms, may facilitate more appropriate and timely use of PRT. In this pilot study patient-directed educational material describing PRT was developed and used among patients being treated in medical oncology and palliative care clinics. The hypothesis is that most patients will gain new knowledge from educational content about PRT, and perceive it as useful in their care. Materials/Methods: A 1-page educational handout was developed to convey general information about the purpose, logistics, benefits, risks, and common indications for PRT. Patients undergoing treatment for a metastatic solid tumor were invited to participate during their regular clinic visit. Patients who chose to participate read the handout, and then completed a multiple choice questionnaire assessing how much they learned from the handout (nothing vs. little vs. lots), whether the information in the handout was useful (no vs. somewhat vs. very), as well as other questions. Responses were anonymous. There was no follow-up with participants. Descriptive statistics are reported, with Fisher’s Exact Test used to compare subgroups of patients. Results: A total of 70 patients from 1 palliative care physician and 4 medical oncologists participated between June – December 2021. Sixty-five patients (89%) felt they learned from the handout (38% learned “lots”) and 69 (94.5%) felt the information was useful (53% “very useful”). Twenty-one patients (28.8%) learned that PRT can help with symptom relief, 55 (75%) learned that PRT can be delivered in a course of 5 treatments or less, and 43 patients (59%) learned that PRT usually has few side effects. Furthermore, 16 (22%) felt they currently had symptoms not being treated well enough, and 34 (47%) felt they currently had symptoms that radiation might help with. Most patients felt more comfortable bringing symptoms to a medical oncologist’s (n = 57, 78%) or radiation oncologist’s (n = 51, 70%) attention after reading the handout. Forty-one patients (56.2%) reported a prior visit with a radiation oncologist, but this did not impact their responses related to learning from the handout ( p< 0.001) or finding the handout useful ( p< 0.001). Conclusions: Patient-directed educational material about PRT provided outside of a radiation oncology department was perceived by patients as improving their knowledge, and adding value in their care, independent of their prior exposure to a radiation oncologist. Further research will evaluate the impact of the educational material on referral patterns.

11050 Background: Industry partnerships offer financial incentives, prestige, and can facilitate career advancement in oncology. However, not all physicians may have equal access to these opportunities. We hypothesized that physicians who are underrepresented in the medical oncology workforce based on race, ethnicity, and gender receive less industry funding. Methods: All US medical oncologists (MOs) who received ≥1 industry research payment between 2016 and 2020 according to the Open Payments database were included in this retrospective study. Information extracted from Open Payments included MO’s name, institution, research payments (i.e. funding for a research project where the physician is a Principle Investigator), and general payments (i.e. fees not associated with research, such as consulting and travel fees). Additional web searches were conducted using institutional websites, NPPES NPI registry, LinkedIn, Doximity, Scopus, and NIH RePORTER to determine each MO’s race, ethnicity, sex, academic rank, degrees, h-index, institutional NIH research funding rank, and individual receipt of NIH funding. Log-linear regression was performed to identify associations of both industry and general payment data. Results: Of 7,542 physicians meeting inclusion criteria, 69% were male, 65% White, 29% Asian, 2% Black, and 4% Hispanic, which is comparable to the American Medical Association Physician Masterfile figures for MO. The median sum research payment and general payment was $134,857 and $11,537 per physician respectively. Significantly higher mean research payments were associated with an MS (+72%; P = 0.003) or PhD degree (+30%; P = 0.009), h-index (+3%; P < 0.001), top 50 institution rank by NIH funding (+44%; P < 0.001), and associate professor rank (+95%; P < 0.001). Significantly lower mean research payment were observed for Black physicians (-36%; P = 0.022) and those with non-academic affiliation (-47%; P < 0.001). No significant association was observed between sex and research payment. Significantly higher mean general payments were associated with male sex (+46%; P < 0.001), MS degree (+171%; P < 0.001), h-index (+2%; P < 0.001), and Asian race (+72%; P < 0.001). Significantly lower mean general payments were associated with an affiliation with a non-academic practice (-31%; P = 0.012). Conclusions: Black physicians received smaller sums of industry research payments compared to White physicians. Female sex was associated with decreased general payments compared to male sex. Further exploring the underlying mechanisms determining access to industry payments may help facilitate greater equity and inclusivity in oncology.