New York ? The rising cost of cancer research and care, which helped reduce death rates by 16 percent over 40 years, is straining the U.S. health system and needs to be restrained, commentators said in a special edition of the Journal of the American Medical Association.

Cancer research has cost the U.S. government $100 billion since 1971 and the price of care, accounting for inflation, has more than doubled to $90 billion since 1990, according to six journal reports that raise key questions about the past and future success of the U.S. “War on Cancer,” announced by then-President Richard Nixon in 1971.

The reduced death rates result from anti-smoking campaigns, early disease detection and new drugs, which can cost individual patients as much as $100,000 a year. The price of the drugs, and the care tied to their use, can be lowered by shifting to a system in which the cost of drugs, tests and other care are combined in a single provider payment, researchers said.

Such a system would push doctors to “shop carefully for the services” patients need, wrote the researchers from the Memorial Sloan-Kettering Cancer Center in New York, led by Elena Elkin in a commentary that was among those included in the special issue. “The expanding financial burden of cancer” including rising incidence rates “cannot be ignored,” the authors wrote.

The Sloan-Kettering researchers also suggested in their commentary that doctors and hospitals should be grouped into accountable-care organizations. That would nudge physicians to act more cohesively, and could be rewarded by payers for providing care that delivers good results.

Cancer remains the second-leading cause of death in the U.S., killing 562,000 people a year, according to the American Cancer Society in Atlanta. In one survey cited in the journal, almost a quarter of respondents with health insurance said they used most or all of their savings during treatment for the disease.