Pediatric oncology in Norway

With a population of approximately 4.6 million scattered over roughly 320,000 km2, Norway's population density is only ∼14 persons per km2. Almost one third of the country is north of the Arctic Circle, and only one in every 12 Norwegians lives there. Geographically, it is a very long country: the distance from the northernmost point to the farthest south is equal to the distance from the southern border of the country to Rome, Italy. Throughout most of history, Norway has been a poor country, with few natural resources of value. This has changed drastically in the past half century. Today, effective use of hydroelectric resources, industrialization, and 30 years of harvesting oil from the North Sea have made Norway one of the most prosperous countries in Europe. According to the economist, Norway's nominal GDP of US $ 191 billion in 2002 places the country only as 12th out of 19 West European countries, but their relatively small population results in a GDP per person (US $ 37,024), that makes Norway one of the wealthiest countries in the world 1. Free health care access has always been regarded as a basic human right in the Scandinavian countries, including Norway. A small fee is paid for visiting primary health care and outpatient clinics, but hospital services are free of charge for every citizen. Private hospitals are rare, and only recently have private initiatives in health service delivery been accepted as a valid supplement to public sector care. While pediatrics as a discipline evolved in the 19th century, it would take until just over two decades ago for an academic Department of Pediatrics to be established. The first Department of Pediatrics (Fig. 1) was established in January 1833 at The National Hospital (Rikshospitalet) in Oslo, Norway's capital, at a time when Norway had an infant mortality of over 100 per 1,000 life births. Since its inception, the department has been led by only five physicians, providing it with consistency in leadership and direction. Children's Ward at the National Hospital, circa 1883 (courtesy Prof. Sverre Lie). Until 1950, the Department of Pediatrics at the Rikshospitalet remained the only one of its kind in Norway. As such, it played an important role in the development of childhood health care services. In between the two World Wars, the department guided Norway in developing nutritional recommendation for babies and children. Prof. Theodor Bruun Frølich (1870–1947) for example, published several distinguished manuscripts on vitamin C and made great contributions to the nutrition of infants and children 2. In addition, the department contributed in developing effective disease prophylaxis strategies. After WWII, pediatrics as a subspecialty took off in Norway. This was the result of two events. First, the Norwegian Government made children's health a top priority. Second, Sweden, neutral during WWII, expressed a sincere desire after 1945 to contribute to Norway's post-war reconstruction. As a nation, Sweden provided1 Norway with two modern pediatric departments, one built in Oslo as part of the National Hospital, the other in Bergen. Soon thereafter, the Community Hospital in Oslo (Ullevål) also established a Department of Pediatrics. Within the next 15–20 years pediatric departments were established in many provinces. Today there are 19 pediatric departments with a total of 815 beds. In Norway, pediatrics is one of the busiest specialties with over 50,000 admissions annually. The Pediatric Department at the National Hospital in Oslo has been the center of the development of modern pediatrics in Norway. All the major pediatric subspecialties were initiated and developed at this institution. The new department, inaugurated in 1950, was led by Prof. Leif Salomonsen until 1967. Pediatric Hematology/Oncology was pioneered by Prof. Martin Seip together with Prof. Peter Johan Moe in the late 1950s. Dr. Seip had studied with Dr. Louis Diamond in Boston and was the first to describe total lipodystrophy 3, a condition that carries his name (Berardinelli–Seip syndrome). Seip also introduced leukemia therapy in this country in the late 1950s. Prof. Moe's main contribution was the introduction of high-dose methotrexate in the management of leukemia, thereby reducing the need for cranial irradiation in the treatment of this disease 4,5. Prof. Sverre O. Lie, SIOPs host this year, has been part of the pediatric oncology department since 1972. Today, the division is comprised of four staff physicians, three fellows, and 32 nurses. The 14-bed unit serves approximately 50 new patients with cancer each year and, as the only BMT center of the country, 10–20 patients requiring hematopoeitic stem cell transplantation. Together with his Scandinivian colleagues, Prof. Lie founded the Nordic Society of Pediatric Hematology and Oncology (NOPHO) in 1981. As a result, today there are common diagnostic and therapy protocols in Denmark, Finland, Iceland, Norway, and Sweden for many pediatric malignancies, including ALL, AML, and lymphomas. NOPHO has made several seminal contributions to the management of childhood cancers 6-8. In May 2000, the National Hospital (Rikshospitalet) moved to a new site in Gaustad, just outside Oslo. The new Rikshospitalet is aesthetically quite remarkable and has won several architectural awards. The art at this institution is Norway's largest public collection of art outside museums. This hospital currently employs over 4,000 people, including 500 physicians and over 1,500 nurses. The Department of Pediatrics has its own wings (Fig. 2), looking out into the wilderness. One of the two wings hosts the magnificent oncology ward. The National Hospital is host to the pre-congress meeting and is certainly worth a visit. Pediatric wings of new Children's Hospital, summer 2000 (courtesy Prof. Sverre Lie). With gratitude for his friendship and help, we acknowledge the input, information, and photographs provided to us by Prof. Sverre Lie. His comments and suggestions have been invaluable in preparing this manuscript.

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