By: Øystein Fodstad

The Norwegian Radium Hospital opened at Montebello on 21 May 1932. The hospital’s history has been characterised by the foresight and commitment of some strong personalities, but also by the general public’s impressive willingness and ability to support a cause that they feel is important. One of the most important things is that an environment has been created at the Norwegian Radium Hospital that promotes a sense of community among the staff and motivates them in their efforts to help patients in their battle against cancer.

A book describing the hospital’s history, with examples of what it stands for, was published to commemorate the anniversary (1). In this article, I will relate the history of the hospital’s development, but I will also try to shed light on some of the reasons why this institution, where I have worked for more than 30 years, has become a very special hospital in the Norwegian health service. The Norwegian Radium Hospital has developed into the only comprehensive cancer centre in Norway. I also wish to communicate why it is so important to preserve what has been built, and why we need to continue to invest in it at a time when comprehensive and integrated cancer research, treatment and care are allowing us to make greater strides in progress and innovation than it was possible to imagine only one or two decades ago.

The initiators
It was the two doctors Severin A. Heyerdahl (1870–1940) and Hans L. C. Huitfeldt (1876–1969) who took the initiative to establish the hospital. They organised a fund-raising campaign via Den Norske Kræftfondkomitee (‘the Norwegian Cancer Fund Committee’), and the campaign raised enough funds to start up the new cancer hospital. Dr Heyerdahl and Dr Huitfelt became the first hospital director and chairman of the board, respectively. The whole country supported the fund-raising campaign, and it was only natural that the hospital was called the Norwegian Radium Hospital. It became an independent institution with its own board of directors. King Haakon VII laid the cornerstone on 5 May 1929, and the hospital opened its doors three years later. A new fund-raising campaign was held to finance the purchase of radium, and once again the whole nation contributed: the royal family, the general public, people in influential positions in society, the sports celebrities of the time, artists, newspapers, the postal service, and even the Norwegian state alcohol monopoly Vinmonopolet. A letter from Madame Curie (1867–1934) confirming a small shipment of radium has been kept by the hospital.
The most important figure in the continuing development of the Norwegian Radium Hospital is director Reidar Eker (1903–96), whose foresight and efforts cannot be overestimated. His ambition was to build a world-class cancer centre. This ambition may have seemed like megalomania to many, but he achieved his goal in that, among other things, he established a cancer research institute and a cancer registry in addition to the hospital function. This was possible through the assistance of Karl Evang (1902–81), who was the head of the Directorate for Health, and Bjarne Eriksen (1886–1976), CEO of Norsk Hydro. Later, Dr Eker obtained funds to expand the hospital activities through another successful nationwide fund-raising campaign. He also demonstrated greatness by donating fees he received as head of pathology at the hospital to research, instead of putting them in his own pocket. This created possibilities and ensured a flexibility that many can envy today. His ability to recruit the best research talents in important disciplines in the post-war years is well known, and old hands such as Alexander Pihl (born in 1920) and Tor Brustad (born in 1926) can provide many amusing and fascinating examples of how he went about it. Mr Eker and the others who were involved at this time created an environment full of enthusiasm, where everyone wanted to do their best for an important cause. This became part of the soul of the Norwegian Radium Hospital.

The Cancer Registry
Reidar Eker saw the need for cancer epidemiology in Norway, and also realised how important it would be to a leading cancer centre. The establishment of the Cancer Registry of Norway was adopted by the Storting in 1951, and the registry started up at the Norwegian Radium Hospital with its own board of directors the following year. The Cancer Registry is now organisationally affiliated with Rikshospitalet University Hospital-the Norwegian Radium Hospital as an essential part of a comprehensive cancer centre. In addition to its own research, the registry’s close contact with the Norwegian Radium Hospital and the other oncology communities in Norway is vital to both clinical and laboratory research. The enormous developments in molecular medicine in recent years has added a new, exciting aspect to the partnership, and the national quality registers for the different forms of cancer established jointly by the oncology communities and the Cancer Registry will be of great importance to comprehensive and optimal cancer treatment.

Institute for Cancer Research
Norsk Hydro’s Institute for Cancer Research was opened in 1954 in a dedicated research building funded by Norsk Hydro. The institute has undergone continuous development and growth since its exciting initial years. It has expanded geographically as well as in terms of research. A large percentage of the institute’s activities is financed by external funds won in competition with other research communities in Norway and abroad. This reflects the high standard of the research, but also the fact that the management has been flexible and understanding in allowing the institute to adapt to the constant changes that are part of the nature of research. One of the most gratifying aspects is the narrowing of the gap between day-to-day clinical work and laboratory research, with clinical practitioners and researchers now working closely together. Herman Høst (born in 1926), professor and head of clinic, is quoted as having said that ‘the institute might as well have been in Maridalen as in Mærradalen’. Nevertheless, junior doctors in Dr Høst’s time were encouraged to take a doctorate at the institute, and many of these doctors now hold senior positions at the Norwegian Radium Hospital and other hospitals. Good contact between the hospital and institute is crucial if they are to contribute towards developing and improving diagnostics, prognostics and treatment, and if they are to be able to assess the value of new ‘breakthroughs’ in research, new drugs or new diagnostic methods.

Inspiring leadership
In 1983, another doctor and pathologist became director of the Norwegian Radium Hospital. Jan Vincents Johannessen (born in 1941) is well known for his resourcefulness, spiced with a little cheeky audacity, and his wealth of ideas came in handy in a time when the demand for government control of the hospital sector was growing in strength. During that time, he inspired dedication in the staff through contact and discussions with all the professions. As before, there were strong forces that for various reasons disliked the Norwegian Radium Hospital’s special status in Norwegian cancer care, and at one time, the hospital was at risk of being shut down. The Norwegian Radium Hospital had not had a good network of political contacts since Dr Eker’s time, and its management had not always been good at lobbying. However, Jan, as everybody calls him, not only had a large network, but also a special knack of generating publicity, and sometimes controversy, on his own account and on behalf of the hospital, such as the time he proposed bringing the new Rikshospitalet to Montebello, but the Norwegian Radium Hospital was saved. Jan is also known for his tireless efforts in establishing activities aimed at promoting the well-being of patients and their families, such as the bus service and cars for patients, the art library, wellbeing centre, ‘gourmet food’, recreational activities, youth room and the Montebello Centre. These are things that should be given priority for such a vulnerable patient group as cancer patients, even at a time of shrinking hospital budgets. Neither the public health administration nor politicians in charge of healthcare can completely disclaim responsibility for the negative consequences of budget cuts in these areas too. The hospital is still struggling with old buildings, but we have received some important encouragement in the form of the new radiation therapy building and the new research building.

The Norwegian Cancer Society
The support of the Norwegian Cancer Society has been, and still is, invaluable to research at the Norwegian Radium Hospital, not least with its recruitment scholarships and operating grants. Recently, the Research Council of Norway has contributed significant funding to some major projects, while support from the Norwegian Radium Hospital Foundation has ensured flexibility and made it possible to invest in projects at an early stage. Cooperation with industry has been excellently regulated by the Norwegian Radium Hospital Research Foundation, and the potential of the Norwegian Radium Hospital in this context is emphasised by the fact that many Norwegian and international enterprises are joining forces to build Oslo Cancer Cluster based at the Norwegian Radium Hospital.

Comprehensive Cancer Centre
Approval as a comprehensive cancer centre requires a broad range of high-quality research, in addition to an epidemiological and preventive unit. During the past few years, I have participated in the development of a new cancer centre in the USA. The goal is to build an integrated cancer centre where clinicians and laboratory researchers can work closely together, and where staff, patients and patients’ families are in frequent contact with each other; exactly the type of institution we have long had in the Norwegian Radium Hospital, and it which has now become the goal for other large cancer centres here and in the rest of Europe to achieve. In an international context, the Norwegian Radium Hospital’s research is of a high standard in relation to the institution’s size and funds. We also have access to well-documented sample material with clinical follow-up data, which is a treasure trove for research, and we have an excellent clinical trials unit. What the Americans most envy is our Norwegian Cancer Registry in its current form and organisation. The research misconduct scandal that recently attracted considerable attention in Norway has not damaged our reputation; the general opinion is just that these things happen and that introducing even stricter control systems cannot guarantee that they will never happen again. It is an unfortunate trend in Norway and abroad that the most highly qualified people are being assigned more and more administrative duties and given less time for the work they should be doing. An unnecessarily large amount of control measures and documentation is detrimental rather than beneficial to any good cause. Norway needs the Norwegian Radium Hospital as a comprehensive cancer centre, perhaps more now than ever, and a merger with Rikshospitalet University Hospital should reinforce the concept of a comprehensive cancer centre even further. The total knowledge that such a centre can provide could actually result in savings for society as a whole, while giving patients early access to the latest quality-assured diagnostic and therapeutic options.

This article was written by Øystein Fodstad, former director of the Institute of Cancer Research, to the hospital`s 75 year anniversary.

References
1. Åmås KO, ed. Livet med kreft. Oslo: Aschehoug, 2007.
The manuscript was received on 22 May 2007 and approved on 22 May 2007. Medical editor: Jan C. Frich.

 

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