For 37 years, registered dietitian Paula Charuhas Macris, MS, RD, has been a steady presence at Fred Hutch Cancer Center, using her nutrition expertise to help blood and marrow transplant and cancer patients maintain strength and resilience as they go through treatment.
When she took her first nutrition class as an undergraduate student at the University of Washington in 1979, she felt an immediate connection with the field of nutrition and decided to pursue a degree as a registered dietitian. After obtaining her Bachelor of Arts degree in nutrition, Charuhas Macris went on to earn her master’s degree in nutrition at UW as well.
“I was always interested in pursuing a degree in the health care field,” Charuhas Macris said. “While taking a general nutrition class, it was fascinating to learn how nutrition and diet therapy played a huge role in the management of certain diseases and conditions. I knew then that I wanted to pursue this as a career and decided to apply to the clinical dietetics program to become a registered dietitian.”
Today, she serves as supervisor of Fred Hutch’s Medical Nutrition Therapy Services and sees adult allogeneic (donor cell) transplant patients, long-term follow-up transplant patients and survivorship clinic patients at the Fred Hutch South Lake Union Clinic.
When she began her professional career at Fred Hutch in 1987, Charuhas Macris was one of a group of nine dietitians who worked exclusively with patients receiving BMTs — a revolutionary treatment recognized worldwide, that was first pioneered by Fred Hutch’s E. Donnall Thomas, MD, a physician who went on to win the Nobel Prize for this work.
Charuhas Macris worked directly with Thomas when he served as an attending physician on the transplant unit. She described him as “a very kind and caring person who recognized the importance of patients maintaining a good nutrition status during transplant and valued the input of the dietitian.”
She also said she felt extremely fortunate to work with the director of the nutrition program at that time, Saundra Aker.
“She was the first BMT dietitian in the world, and she developed Fred Hutch’s nutrition program along with Dr. Thomas,” Charuhas Macris said. “Like Dr. Thomas, Saundra Aker pioneered care for BMT patients, but through nutrition. She made sure that dietitians were always included in patient care at Fred Hutch, which has continued to this day.”
Charuhas Macris has witnessed multiple advances in both medicine and nutrition since those early days and has worked with hundreds of patients, both children and adults, including some who have stayed in touch with her over the years.
“It’s rewarding over these many years to be able to work with patients throughout their treatment and to provide nutritional guidance when they experience treatment-related side effects, then to share in the joy of their recovery,” she said.
When she first arrived at Fred Hutch, all medical records were paper-based like at nearly every medical facility at the time, and paging systems and landline phones were the primary modes of communication. BMT patients resided in highly sterile airflow rooms to help reduce the risk of infection. The kitchen was located on the same floor as the transplant unit, explained Charuhas Macris, and was open from 6 a.m. to midnight to help meet the needs of the patients.
“We had wonderful research cooks who really catered to the patients and went out of their way to prepare their meals and snacks,” she said.
Part of the role of the dietitian was to identify healthy foods and fluids the patient could tolerate that would help support them during treatment. And as their needs changed, the dietitian would continually monitor the whole patient (considering multiple factors, like fluid intake, weight loss, changing tastes and symptoms such as vomiting) and seek out new options that would work.
Additionally, patients often required parenteral nutrition (where nutrients are delivered to the bloodstream using an IV). Charuhas Macris said that parenteral nutrition is not used as often anymore because it has been replaced by tube feeding.
The roles of registered dietitians, including Charuhas Macris, have expanded thanks to leading-edge research, the adoption of personalized nutrition plans and an ever-deepening understanding of how food impacts treatment outcomes.
Charuhas Macris said she is particularly excited about recent evidence-based research into the gut microbiome that is demonstrating the important role nutrition plays in health. She and Kerry McMillen, MS, RD, director of Fred Hutch’s Oncology Supportive Care and Screening, gave a presentation last fall on the subject, “Emerging Role of Diet and the Gut Microbiome in Oncologic Therapy: Cancer Prevention Through Survivorship”, at the Academy of Nutrition and Dietetics’s Food & Nutrition Conference & Expo.
“Researchers have learned that the more plants we eat, the more diverse our guts become. As far as BMT patients are concerned, this may mean that supporting the microbiome may have a positive effect on conditions such as gut graft-vs.-host disease,” Charuhas Macris said. “It is so fascinating to know that food can play a role in changing outcomes. I’m excited to move forward with that.”
Medical Nutrition Services has grown since Charuhas Macris first came to Fred Hutch, and today the program covers all general oncology clinics including prevention and survivorship clinics, immunotherapy, telehealth visits and all Fred Hutch community sites and is made up of 15 registered dietitians.
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Every new transplant patient at Fred Hutch undergoes a nutrition-focused physical exam before they begin treatment, either with a Fred Hutch registered dietitian or with a UW Medicine nutrition staff member if they are a direct inpatient admission for treatment at UW Medical Center – Montlake. During this exam, the dietitian looks for physical signs of malnutrition (such as muscle and adipose wasting), which Charuhas Macris explained has been a valuable tool to help rule out malnutrition.
Many factors are taken into consideration when planning nutrition for patients who are having a BMT or other cancer treatment, including cultural factors that might impact the foods they eat, as well as personal preferences.
“Some BMT patients think they will need to change their diet completely, but that is not true,” Charuhas Macris said. “They just need to be mindful of certain foods.”
Most allogeneic BMT patients are discharged around day 100. After a patient completes treatment for their cancer or disease, they can contact Fred Hutch Medical Nutrition Therapy Services at any time for support. Since cancer patients are at a greater risk for infection, food safety is always top of mind as well. Fred Hutch dietitians work closely with patients before, during and after care to educate them on food safety.
When asked what she enjoys most about her work — and what has inspired her to remain dedicated to her career for nearly four decades — Charuhas Macris said it’s the people.
“What I enjoy most about my work is the patient care, building relationships with patients and working with them at a critical time in their treatment,” she said. “I try my best to support them when they are going through hard times, and rejoice with them when they make great strides.”
March is National Nutrition Month
Learn about Medical Nutrition Therapy Services at Fred Hutch. Or, view patient education resources on nutrition for cancer patients.
About our Heart of the Hutch series
We have been profiling people who illustrate the culture and spirit of Fred Hutch with the Heart of the Hutch series. This edition focuses on our outstanding clinicians, administration employees and patient-facing staff.
This series highlights just a few of the thousands of people within the Fred Hutch community who are the Heart of the Hutch.
Maren Dale is a health care writer and editor. Her keen interest in, and respect for, the medical community began early in life when her family relocated to Rochester, Minn., and she attended Mayo High School. She has interviewed more than 600 physicians, researchers and health care leaders, and has a sub-specialty writing for professional medical associations. Reach her on LinkedIn or at maren@maren-dale.com.
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