Cognitive burden and supportive care needs in dyads of older patients with hematologic malignancies and their primary caregivers: a cross-sectional survey

Older patients with hematologic malignancies often rely heavily on family caregivers, who face substantial cognitive demands in understanding complex medical information and making treatment-related decisions. However, the cognitive burden and support needs within patient–caregiver dyads remain underexplored. This study aimed to assess cognitive burden and support needs in older patients with hematologic malignancies and their primary caregivers from a dyadic perspective, compare differences between dyads, and identify factors associated with caregivers’ cognitive burden. This cross-sectional dyadic study enrolled 428 older patients (aged ≥ 60 years) with hematologic malignancies and their primary caregivers. Both completed identical questionnaires measuring cognitive burden, communication difficulties, and support needs. Paired comparisons and multiple linear regression analyses were performed. Caregivers reported significantly higher scores than patients across all domains: total cognitive burden (42.79 ± 11.03 vs. 33.68 ± 11.79, P < 0.001), communication difficulties (15.89 ± 6.51 vs. 12.54 ± 6.28, P < 0.001), and support needs (30.84 ± 6.42 vs. 26.21 ± 7.04, P < 0.001). The proportion of caregivers with high cognitive burden (20.3%) more than doubled that of patients (9.6%). Top caregiver needs included emergency warning cards, medication lists, and care skills guidance. Communication difficulties were most strongly associated with caregiver cognitive burden (standardised β = 0.49, P < 0.001), along with caregiving time > 8 h (β = 0.27), and relapsed/refractory or palliative phase (β = 0.22). Primary caregivers of older patients with hematologic malignancies bear a significantly higher cognitive burden than patients themselves, particularly those in high-risk subgroups. Clinical interventions should incorporate caregivers into comprehensive care frameworks, with emphasis on structured communication support, practical care tools, and targeted support at critical disease phases.