# Stress Estimation in Elderly Oncology Patients Using Visual Wearable Representations and Multi-Instance Learning

arXiv: https://arxiv.org/abs/2604.06990 · HTML: https://mlsanity.com/paper/2604.06990/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 5 of its 30 references that are in the map.
- First posted on arXiv 8 Apr 2026.

## Builds on (most cited first, 5 of 5)

- [Switch Transformers: Scaling to Trillion Parameter Models with Simple and Efficient Sparsity](https://mlsanity.com/paper/2101.03961/) (2021)
- [Generalizable machine learning for stress monitoring from wearable devices: A systematic literature review](https://mlsanity.com/paper/2209.15137/) (2022)
- [Multi-Representation Diagrams for Pain Recognition: Integrating Various Electrodermal Activity Signals into a Single Image](https://mlsanity.com/paper/2507.21881/) (2025)
- [Tiny-BioMoE: a Lightweight Embedding Model for Biosignal Analysis](https://mlsanity.com/paper/2507.21875/) (2025)
- [Extending Stress Detection Reproducibility to Consumer Wearable Sensors](https://mlsanity.com/paper/2505.05694/) (2025)

## Abstract (arXiv)

Psychological stress is clinically relevant in cardio-oncology, yet it is typically assessed only through patient-reported outcome measures (PROMs) and is rarely integrated into continuous cardiotoxicity surveillance. We estimate perceived stress in an elderly, multicenter breast cancer cohort (CARDIOCARE) using multimodal wearable data from a smartwatch (physical activity and sleep) and a chest-worn ECG sensor. Wearable streams are transformed into heterogeneous visual representations, yielding a weakly supervised setting in which a single Perceived Stress Scale (PSS) score corresponds to many unlabeled windows. A lightweight pretrained mixture-of-experts backbone (Tiny-BioMoE) embeds each representation into 192-dimensional vectors, which are aggregated via attention-based multiple instance learning (MIL) to predict PSS at month 3 (M3) and month 6 (M6). Under leave-one-subject-out (LOSO) evaluation, predictions showed moderate agreement with questionnaire scores (M3: R^2=0.24, Pearson r=0.42, Spearman rho=0.48; M6: R^2=0.28, Pearson r=0.49, Spearman rho=0.52), with global RMSE/MAE of 6.62/6.07 at M3 and 6.13/5.54 at M6.