Supportive Care Services

Medical Nutrition Therapy Services

Proper nutrition is vital for people with cancer and directly supports their treatment and recovery. It can play a key role in cancer prevention as well as help prevent a cancer or disease from returning after treatment.

At Fred Hutchinson Cancer Center Medical Nutrition Therapy Services, our registered dietitians are extensively trained in cancer care, and work with patients who are facing a full range of cancer types, stages and needs. We not only help manage treatment-related symptoms but proactively help patients maintain strength and healthy body tissue, both during treatment and afterward. Our services are free and available exclusively to Fred Hutch patients.

Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

How we can help

Every patient is different, every cancer or disease is different, and a patient’s needs can change over time when it comes to nutrition. Our team will work closely with your physician to discuss how your specific diagnosis or treatments are affecting you. Using that information, we work with you to create a nutrition plan.

Here are some of the reasons patients come to us:

Before treatment
  • To understand what foods are best to eat when going through treatment
  • To discuss common myths or misconceptions about nutrition and cancer
During treatment
  • To help maintain strength and weight
  • To manage side effects, such as taste changes, nausea or low appetite
  • To manage nutrition support recommendations, such as tube feeding or intravenous nutrition
  • To help manage diagnosis-specific nutrition issues, such as difficulty swallowing during radiation treatment
Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
After treatment/survivorship
  • To discuss disease-specific diet and nutrition recommendations, including the long-term impacts of treatment
  • To review appropriate diet guidelines to help prevent recurrence or a secondary cancer
  • To develop a plan for weight management
Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer.
“Often, patients are surprised to know that food is important in cancer prevention and survivorship. Our registered dietitians have specific expertise to address diet recommendations that help patients live their best lives.”
— Kerry K. McMillen, MS, RD, CSO, FAND, Manager, Medical Nutrition Therapy Services
Fred Hutch Medical Nutrition Therapy Services
Meet some of the Fred Hutch dietitians who are trained to help you create a nutrition plan specific to your treatment, diagnosis, health and foods you like.

Frequently Asked Questions (FAQs)

What is the difference between a registered dietitian (RD) and a nutritionist?

Registered dietitians (RDs) are nutritionists who have received extra training and certification. At Fred Hutch, all our staff are registered dietitians.

Registered dietitians are credentialed food and nutrition experts. To earn this designation, they must go through extensive training and formal education, including completing an internship and passing a national registration exam. Our registered dietitians provide medical nutrition therapy, which means they use an evidence-based approach (based on substantial scientific research ) to treat and help patients manage medical conditions through diet and nutrition. 

The Commission on Cancer (CoC) is an organization that sets professional standards for cancer care, and Fred Hutch is an accredited CoC hospital. One of CoC’s rules is that cancer patients can be referred only to registered dietitians (not nutritionists) for medical nutrition therapy. 

What is medical nutrition therapy?

Medical nutrition therapy focuses on managing a disease or condition using nutrition. It is an evidence-based approach, which means it is based on substantial scientific research about the right foods and/or nutrients to treat medical conditions. 

To do this work, a registered dietitian must carefully assess patients using their special expertise, then develop an individual nutrition plan to help them. They also need to regularly monitor and evaluate the patient, since needs can change and the nutrition plan may need to be adjusted. At Fred Hutch, education and counseling are also important parts of medical nutrition therapy, helping patients maintain proper nutrition and stay as healthy as possible before, during and after treatment. 

What does CSO stand for and what does it mean?

A CSO is a registered dietitian who is also a board-certified specialist in oncology (cancer) nutrition. To become a CSO, a registered dietitian must complete a minimum of two years of clinical practice with 2,000 hours of documented experience in cancer care, in addition to passing a national board certification exam. 

All registered dietitians at Fred Hutch are either CSOs or are actively working toward this certification. This professional credential is earned through the Commission on Dietetic Registration (CDR), the credentialing agency for the Academy of Nutrition and Dietetics.

Can Fred Hutch help people who have specific food requirements?

Yes. Our team respects the dietary needs and choices of all patients. Because Fred Hutch is a nationally recognized cancer center, people of different cultures and ethnicities come to us from all over the world for treatment. As registered dietitians, we have experience developing nutrition plans that honor diverse beliefs and needs as well as specific diet preferences. 

I’m worried about being able to afford the foods I’m supposed to eat. What should I do?

We are here to help, and our registered dietitians will partner with you to build a nutrition plan that will support your health while keeping your budget in mind. As part of our team-based approach to patient care, we work closely with Fred Hutch’s patient navigation and social work teams. These teams help to connect patients and families who are going through financial difficulties with resources that can help them.

Are there special supplements/diets to use when going through cancer treatment?

Our registered dietitians provide science-based recommendations. We partner with Fred Hutch’s Integrative Medicine Program and pharmacy team to make sure supplements and dietary products are safe before recommending them to our patients. We also give evidence-based (based on substantial scientific research) recommendations on questions about diet changes/regimens while you are undergoing your personalized treatment plan.

Watch Food Safety Video

Integrative medicine Combines conventional (standard) medical treatment with complementary and alternative (CAM) therapies that have been shown to be safe and to work. CAM therapies treat the mind, body and spirit. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
What is nutrition support?

Sometimes having cancer or a cancer treatment can affect your ability to swallow and digest food. This means you might need temporary physical nutrition support, such as tube feeding or intravenous (IV) nutrition, to make sure your calorie and protein needs are being met. We work closely with your physician to decide if this is the best option for you. 

What happens at your first appointment

Before your first visit to Medical Nutrition Therapy Services, one of our registered dietitians will go over your medical records in detail. After they review your records and meet with you, they will suggest options for your personalized nutrition plan. We encourage you to bring your caregiver with you to your appointment, so you can both ask questions and better understand the nutrition recommendations and plan. We also suggest you write your questions down in a notebook before your first appointment. This will help make sure your questions get answered, and you’ll have a place to take notes.

If you are coming to us before or during cancer treatment

At your visit, we’ll discuss any issues or concerns you may have. You might need help managing a side effect. Or you might be wondering how you can stay as strong as possible and maintain your weight. Maybe you’re concerned you’ll have to eat certain foods or won’t be able to eat others. Whatever your questions or concerns, we are here to listen and to help develop a plan that works for you. 

Once we have a better understanding of your needs, we’ll ask you questions to better understand where you are right now — such as what you’re currently eating, any issues that have come up since your diagnosis and your weight history. We’ll also ask you about how active you are or are able to be. 

Our goal is to set nutrition goals with you by the end of this first appointment. Together, we’ll discuss in detail how we’ll change your diet to help you. When you leave your appointment, you should have a clear understanding of your nutrition goals, such as your calorie, protein and fluid needs; how to meet these needs if you have to change your diet due to treatment-related symptoms; and specific dietary strategies to help manage treatment-related symptoms like a sore mouth and throat, diarrhea or constipation. For example, many patients struggle with low appetite or feeling full quickly. Using a whole-foods approach, we will discuss eating smaller, more frequent meals, including calorie-dense foods such as nut butters or avocado, and the benefits of drinking calorie-protein-containing fluids like smoothies or soups.

Before you leave, we’ll figure out when you need to schedule your next appointment so we can follow up and see how the nutrition plan is working as well as address any new concerns or symptoms. If you are in active treatment and having difficulty meeting your nutrition goals, we’ll set a follow-up plan with you. Often, these appointments are every one to two weeks. If you develop new issues as you go through treatment, your physician will refer you to us for another appointment.

If you are coming to us for cancer prevention

Some Fred Hutch patients do not have cancer, but they’ve been identified as someone who is at high risk of developing a cancer. This might be due to their genetics, family history or other reasons. They often receive care from one of our prevention teams, such as our High Risk Surveillance Clinic, Gastrointestinal Cancer Prevention Program or the Breast and Ovarian Cancer Prevention Program. We work closely with these teams and help people who are referred to us from them.

During your appointment, we’ll ask you about your current diet, find out about any food sensitivities or preferences and more. Once we have the answers and a better picture of your current diet and activity level, we’ll be able to offer nutrition recommendations. You’ll leave the appointment with an understanding of the foods that may increase your risk of developing cancer and how you can decrease that risk through the foods you choose to eat. 

If you need support after your cancer treatment (survivorship)

Once you have completed active treatment, you may return to Fred Hutch for survivorship or surveillance (monitoring) appointments. In addition, if you have any nutrition-related issues or questions, your physician will schedule an appointment for you with our team. At this appointment, a registered dietitian will ask you about your diet and develop an eating plan to manage any issues, including ongoing digestion, weight and/or metabolic issues such as high glucose or cholesterol levels. We’ll also review established guidelines from a diet perspective to reduce the risk of your cancer returning.

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting. Gastrointestinal Refers to the stomach and intestines. Also called GI. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Surveillance Closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. In medicine, surveillance means closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. It may also be used for a person who has an increased risk of a disease, such as cancer. During surveillance, certain exams and tests are done on a regular schedule. In public health, surveillance may also refer to the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age or ethnic group. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
Alert icon
COVID-19 notice

Currently, there is no evidence to suggest that COVID-19 can be transmitted through food or water systems. However, you can take extra steps to help protect your health while preparing, cooking and shopping for food.

For more information, download our "Food, nutrition and COVID-19" PDF in the Resources section below.

Resources

Below is a list of online resources provided by both Fred Hutch and trusted organizations that you may find helpful for learning about food safety and nutrition. 

Food, nutrition and COVID-19
Food, nutrition and COVID-19

This document answers common questions and explains extra steps you can take when preparing, cooking and shopping for food.

New Day Northwest
New Day Northwest

Fred Hutch dietitians provide a medical nutrition therapy demonstration on New Day Northwest.

Cook For Your Life
Cook For Your Life

A free bilingual cooking resource teaching healthy eating to people affected by cancer, founded by a three-time cancer survivor in partnership with Fred Hutch. 

American Institute for Cancer Research
American Institute for Cancer Research

The American Institute for Cancer Research (AICR) has an online resource library full of videos, infographics and other nutrition resources related to cancer prevention and survival.

Care team

Find care team profiles 

Meet the caring, dedicated dietitians who take care of you and your family at Fred Hutch. 

Laura Buono, RD, CSO, CD, CNSC
Laura Buono, RD, CSO, CD, CNSC

Laura Buono is a registered dietitian with 20 years of experience. She works with hematopoietic cell transplant patients at the South Lake Union clinic and provides care to general oncology patients at Fred Hutch at UW Medical Center – Northwest. She has taught graduate-level medical nutrition therapy for 10 years. Laura is a board-certified specialist in oncology nutrition and a certified nutrition support clinician.

Linda Kasser, RD, CSO, CD
Linda Kasser, RD, CSO, CD

Linda Kasser has more than 40 years of experience as a registered dietitian. She works primarily with patients who have gastrointestinal cancers and sees patients receiving care at our South Lake Union clinic, Fred Hutch at Overlake and our Issaquah clinic. Linda is a board-certified specialist in oncology nutrition.

Paula Charuhas Macris, MS, RD, CSO, FAND, CD
Paula Charuhas Macris, MS, RD, CSO, FAND, CD

Paula is a registered dietitian with more than 30 years of experience in cancer care. Paula works primarily with hematopoietic cell transplant patients at our South Lake Union clinic and at the Fred Hutch Survivorship Clinic. She has a special interest in working with children and families. Paula is a fellow of the Academy of Nutrition and Dietetics and is a board-certified specialist in oncology nutrition.

Patty McDonnell RD, CSO, CD, FAND
Patty McDonnell RD, CSO, CD, FAND

Patty McDonnell is a registered dietitian with more than 20 years of experience in cancer care. Patty primarily works with patients who have blood cancers, sarcoma and genitourinary cancers and sees patients at our South Lake Union and Issaquah clinics. She is a fellow of the Academy of Nutrition and Dietetics and is a board-certified specialist in oncology nutrition.

Kerry McMillen, MS, RD, CSO, CD, FAND
Kerry McMillen, MS, RD, CSO, CD, FAND

Kerry McMillen is a registered dietitian who has worked with cancer patients for more than 20 years. She is the manager of Fred Hutch Medical Nutrition Therapy Services, works with patients at all Fred Hutch clinic locations and has a special interest in working with hematopoietic cell transplant patients. Kerry is a fellow of the Academy of Nutrition and Dietetics and is a board-certified specialist in oncology nutrition.

Tal Ozery, MS, RD
Tal Ozery, MS, RD

Tal Ozery is a registered dietitian who works with patients at risk of developing a gastrointestinal cancer. She also sees patients with head and neck cancers. Tal has a special interest in counseling patients with eating disorders. She cares for patients at our South Lake Union, Peninsula and Issaquah clinics. 

Raymond Palko, MS, RD, CSO, CD
Raymond Palko, MS, RD, CSO, CD

Raymond Palko is a registered dietitian who works with patients who are at high risk of developing breast or ovarian cancer. He also works with patients with breast, renal and endocrine cancers and melanoma, as well as supporting them after treatment. Raymond sees patients at our South Lake Union and Issaquah clinics. Raymond is a board-certified specialist in oncology nutrition.

Mary Rasmussen, MS, RD, CSO, CD
Mary Rasmussen, MS, RD, CSO, CD

Mary Rasmussen is a registered dietitian who works with autologous transplant and cellular immunotherapy patients at our South Lake Union clinic. She is a board-certified specialist in oncology nutrition and has more than 10 years of experience in cancer care.

Erin Schmidt, RD, CSO
Erin Schmidt, RD, CSO

Erin Schmidt is a registered dietitian who has worked extensively with allogeneic hematopoietic cell transplant patients at our South Lake Union clinic for more than 10 years. She is a board-certified specialist in oncology nutrition.

Hailey Wilson, MS, RD, CD, CNSC
Hailey Wilson, MS, RD, CD, CNSC

Hailey Wilson is a registered dietitian who works with gastrointestinal, thoracic, head and neck cancer patients at our South Lake Union and Issaquah clinics. She has eight years of experience and is a board-certified nutrition support clinician.